{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T17:45:05Z","timestamp":1776361505127,"version":"3.51.2"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BaroPace Inc. Issaquah, WA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Heart failure with preserved ejection fraction (HFpEF) represents approximately 50% of all heart failure cases and lacks effective treatments. Chronotropic incompetence contributes to exercise intolerance in these patients. This study evaluated the safety and efficacy of blood pressure\u2013adaptive atrial pacing (BPAP) vs standard bradycardia pacing (STD) in hypertensive patients with HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, double-blind, randomized, self-controlled crossover study, 16 patients (mean age: 62.7 \u00b1 10.9 years; 6% female; left ventricular ejection fraction 55.3 \u00b1 3.8%) with treated hypertension and implanted dual-chamber pacemakers underwent two 3-week treatment phases (BPAP and STD) in random order. The BPAP algorithm\u2013modulated atrial pacing rate in response to home blood pressure readings. Endpoints included the Minnesota Living With Heart Failure (MLWHF) score, New York Heart Association (NYHA) class, 6-minute walk test (6MWT), and modified Bruce treadmill test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>BPAP improved MLWHF score by an additional 15% from baseline (P = .0288), whereas STD showed a non-significant 3% worsening. Exercise time increased significantly during BPAP (+83.2 \u00b1 55.6\u2005s, P = .005) but not during STD (+70.8 \u00b1 84.4\u2005s, P = .095). The 6MWT distance rose by 35.8 \u00b1 29.9\u2005m during BPAP (P = .003) vs minimal change with STD (+8.2 \u00b1 40.1\u2005m, P = .6). NYHA class improved in 55.6% of BPAP patients vs 11% with STD (P = .0455). Mean heart rate was higher during BPAP (83.8 \u00b1 8.3 bpm) than STD (72.9 \u00b1 12.0 bpm, P &amp;lt; .0001), with no difference in systolic blood pressure (137.5 \u00b1 14.9 vs 138.6 \u00b1 14.0\u2005mmHg, P = .68). No adverse events occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In hypertensive patients with HFpEF and implanted pacemakers, BPAP safely improved exercise capacity and functional status compared to standard pacing. The approach demonstrates feasibility of home-based blood pressure\u2013modulated pacing for physiologic rate adaptation. (NCT06036186)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvaf020","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T18:02:04Z","timestamp":1768845724000},"source":"Crossref","is-referenced-by-count":1,"title":["Adaptive blood pressure\u2013modulated atrial pacing in hypertensive HFpEF patients: a randomized, first-in-human study"],"prefix":"10.1093","volume":"13","author":[{"given":"Michael H","family":"Burnam","sequence":"first","affiliation":[{"name":"BaroPace, Inc. , Issaquah, WA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santosh Kumar","family":"Sinha","sequence":"additional","affiliation":[{"name":"L.P.S Institute of Cardiology & Cardiac Surgery, GSVM Medical College , Swaroop Nagar, Kanpur, Uttar Pradesh ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mukesh Jitendra","family":"Jha","sequence":"additional","affiliation":[{"name":"L.P.S Institute of Cardiology & Cardiac Surgery, GSVM Medical College , Swaroop Nagar, Kanpur, Uttar Pradesh ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay Kumar","family":"Sharma","sequence":"additional","affiliation":[{"name":"Maharaja Agrasen Superspeciality Hospital Cardiology Department, , Jaipur ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amitesh","family":"Nagarwal","sequence":"additional","affiliation":[{"name":"NIMS Medical College, NIMS University Cardiology Department, , Jaipur ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohit","family":"Chopra","sequence":"additional","affiliation":[{"name":"C M Chopra Hospital & Heart Care Centre Cardiology Department, , Chomu ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli S","family":"Gang","sequence":"additional","affiliation":[{"name":"BaroPace, Inc. , Issaquah, WA , USA"},{"name":"Cardiovascular Research Foundation, Beverly Hills & Cedars-Sinai Smidt Heart Institute , Los Angeles, CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"2026021112465982600_xvaf020-B1","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1161\/CIRCHEARTFAILURE.108.822627","article-title":"Prevalence of left ventricular diastolic dysfunction in a general population","volume":"2","author":"Kuznetsova","year":"2009","journal-title":"Circ Heart Fail"},{"key":"2026021112465982600_xvaf020-B2","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.jchf.2018.03.003","article-title":"Hemodynamic correlates and diagnostic role of cardiopulmonary exercise testing in heart failure with preserved ejection fraction","volume":"6","author":"Reddy","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2026021112465982600_xvaf020-B3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1097\/00008483-200603000-00007","article-title":"Chronotropic incompetence and its contribution to exercise intolerance in older heart failure patients","volume":"26","author":"Brubaker","year":"2006","journal-title":"J Cardiopulm Rehabil"},{"key":"2026021112465982600_xvaf020-B4","doi-asserted-by":"publisher","first-page":"2138","DOI":"10.1161\/CIRCULATIONAHA.106.632745","article-title":"Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction","volume":"114","author":"Borlaug","year":"2006","journal-title":"Circulation"},{"key":"2026021112465982600_xvaf020-B5","doi-asserted-by":"publisher","first-page":"e1916598","DOI":"10.1001\/jamanetworkopen.2019.16598","article-title":"Association of \u03b2-blocker use with heart failure hospitalizations and cardiovascular disease mortality among patients with heart failure with a preserved ejection fraction: a secondary analysis of the TOPCAT trial","volume":"2","author":"Silverman","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026021112465982600_xvaf020-B6","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1161\/CIRCULATIONAHA.115.017119","article-title":"Effect of selective heart rate slowing in heart failure with preserved ejection fraction","volume":"132","author":"Pal","year":"2015","journal-title":"Circulation"},{"key":"2026021112465982600_xvaf020-B7","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1093\/eurheartj\/ehx564","article-title":"Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials","volume":"39","author":"Cleland","year":"2018","journal-title":"Eur Heart J"},{"key":"2026021112465982600_xvaf020-B8","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.rec.2016.10.017","article-title":"The syndrome of heart failure with preserved systolic function","volume":"70","author":"Sarwar","year":"2017","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"2026021112465982600_xvaf020-B9","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1001\/jamacardio.2022.5320","article-title":"Effect of personalized accelerated pacing on quality of life, physical activity, and atrial fibrillation in patients with preclinical and overt heart failure with preserved ejection fraction: the myPACE randomized clinical trial","volume":"8","author":"Infeld","year":"2023","journal-title":"JAMA Cardiol"},{"key":"2026021112465982600_xvaf020-B10","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2023.0675","article-title":"Rate-adaptive atrial pacing for heart failure with preserved ejection fraction","volume":"329","author":"Reddy","year":"2023","journal-title":"JAMA"},{"key":"2026021112465982600_xvaf020-B11","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1016\/j.jacc.2021.07.014","article-title":"Exercise intolerance in older adults with heart failure with preserved ejection fraction: JACC state-of-the-art review","volume":"78","author":"Pandey","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026021112465982600_xvaf020-B12","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1001\/jama.2023.1053","article-title":"Rate-adaptive pacing for heart failure with preserved ejection fraction","volume":"329","author":"Kitzman","year":"2023","journal-title":"JAMA"},{"key":"2026021112465982600_xvaf020-B13","doi-asserted-by":"publisher","first-page":"6014","DOI":"10.19102\/icrm.2024.15091","article-title":"Permanent pacing reduces blood pressure in older patients with drug-resistant hypertension: a new pacing paradigm?","volume":"15","author":"Nguyen","year":"2024","journal-title":"J Innov Card Rhythm Manag"},{"key":"2026021112465982600_xvaf020-B14","doi-asserted-by":"publisher","first-page":"2460","DOI":"10.1002\/ehf2.14854","article-title":"Safety and efficacy of adaptive atrial pacing regulated by blood pressure during low-level exercise: a proof-of-concept study","volume":"11","author":"Burnam","year":"2024","journal-title":"ESC Heart Fail"},{"key":"2026021112465982600_xvaf020-B15","doi-asserted-by":"publisher","first-page":"e252","DOI":"10.1016\/j.amjmed.2020.08.030","article-title":"Systolic blood pressure and outcomes in older patients with HFpEF and hypertension","volume":"134","author":"Faselis","year":"2021","journal-title":"Am J Med"},{"key":"2026021112465982600_xvaf020-B16","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1161\/HYPERTENSIONAHA.120.16277","article-title":"Pulse pressure, prognosis, and influence of sacubitril\/valsartan in heart failure with preserved ejection fraction","volume":"77","author":"Suzuki","year":"2021","journal-title":"Hypertension"},{"key":"2026021112465982600_xvaf020-B17","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s10286-023-00948-8","article-title":"Autonomic control of ventricular function in health and disease: current state of the art","volume":"33","author":"Weperen","year":"2023","journal-title":"Clin Auton Res"},{"key":"2026021112465982600_xvaf020-B18","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1161\/CIRCULATIONAHA.124.072156","article-title":"Evidence-based application of natriuretic peptides in the evaluation of chronic heart failure with preserved ejection fraction in the ambulatory outpatient setting","volume":"151","author":"Reddy","year":"2025","journal-title":"Circulation"},{"key":"2026021112465982600_xvaf020-B19","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1056\/NEJMoa2206286","article-title":"Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction","volume":"387","author":"Solomon","year":"2022","journal-title":"N Engl J Med"},{"key":"2026021112465982600_xvaf020-B20","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1056\/NEJMoa2107038","article-title":"Empagliflozin in heart failure with a preserved ejection fraction","volume":"385","author":"Anker","year":"2021","journal-title":"N Engl J Med"},{"key":"2026021112465982600_xvaf020-B21","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1056\/NEJMoa1908655","article-title":"Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction","volume":"381","author":"Solomon","year":"2019","journal-title":"N Engl J Med"},{"key":"2026021112465982600_xvaf020-B22","doi-asserted-by":"publisher","first-page":"1602","DOI":"10.1373\/clinchem.2006.069369","article-title":"Reference change values for brain natriuretic peptides revisited","volume":"52","author":"Fokkema","year":"2006","journal-title":"Clin Chem"},{"key":"2026021112465982600_xvaf020-B23","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/S0002-9149(03)00741-0","article-title":"Biological variation for N-terminal pro- and B-type natriuretic peptides and implications for therapeutic monitoring of patients with congestive heart failure","volume":"92","author":"Wu","year":"2003","journal-title":"Am J Cardiol"},{"key":"2026021112465982600_xvaf020-B24","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1373\/clinchem.2004.038752","article-title":"High intraindividual variation of B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with stable chronic heart failure","volume":"50","author":"Bruins","year":"2004","journal-title":"Clin Chem"},{"key":"2026021112465982600_xvaf020-B25","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1001\/archinternmed.2010.390","article-title":"Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial","volume":"171","author":"Victor","year":"2011","journal-title":"Arch Intern Med"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvaf020\/66460646\/xvaf020.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/13\/1\/xvaf020\/66460646\/xvaf020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/13\/1\/xvaf020\/66460646\/xvaf020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:47:03Z","timestamp":1770832023000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/doi\/10.1093\/eschf\/xvaf020\/8429879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,19]]},"published-print":{"date-parts":[[2026,2,3]]}},"URL":"https:\/\/doi.org\/10.1093\/eschf\/xvaf020","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,1,19]]},"article-number":"xvaf020"}}