Abstract
Despite the availability of many antihypertensive drugs, there is still a sizeable portion of hypertensive patients in whom blood pressure does not fall or is reduced insufficiently during treatment. Treatment resistance, therefore, is one of the challenges of contemporary hypertension research. Since the autonomic system plays a major role in the pathogenesis of hypertension, in particular when this is resistant to drug treatment, investigators have searched for methods to lower sympathetic outflow in the body. One of the methods by which this can be achieved is to activate the baroreceptor reflex by means of an electrical device. Presently, clinical trials are being conducted to assess the clinical usefulness of such a device. So far, the only device that has been tested clinically is the RheosTM Baroreflex Hypertension Therapy System and its successor, the Barostim neo TM device. These are open-loop systems with electrodes that are attached surgically to the carotid artery at close proximity to the bifurcation. While the Rheos device still worked through bilateral stimulation, the other one has been designed for unilateral implantation and stimulation. A feasibility study has shown that baroreceptor activation therapy lowers blood pressure and heart rate significantly in a voltage-dependent way. A randomized trial which compared activation immediately after implantation of the electrodes with that 6 months after implantation confirmed the efficacy of the device although the short-term effects were a bit disappointing. Long-term results are very promising and the side effects are minimal. The sustained reduction in pressure is associated with regression of left ventricular hypertrophy. Renal function remains preserved.
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References
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51(6):1403–19.
Guyton AC, Hall JE, Coleman TG, Manning Jr RD, Norman Jr RA. The dominant role of the kidneys in long-term arterial pressure regulation in normal and hypertensive states. In: Laragh JH, Brenner BM, editors. Hypertension. Pathophysiology, diagnosis, and management. 2nd edn. New York: Raven Press; 1995. pp. 1311–26.
Sleight P. Nonpharmacological treatments for hypertension. J Hypertens. 2012;30(8):1516–7.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA. 2002;288(23):2981–97.
Ludbrook J, Mancia G, Ferrari A, Zanchetti A. The variable-pressure neck-chamber method for studying the carotid baroreflex in man. Clin Sci Mol Med. 1977;53(2):165–71.
Griffith LS, Schwartz SI. Reversal of renal hypertension by electrical stimulation of the carotid sinus nerve. Surgery. 1964;56:232–9.
Hoppe UC, Brandt MC, Wachter R, et al. Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial. Am J Hypertens. 2012;6(4):270–6.
Schmidli J, Savolainen H, Eckstein F, et al. Acute device-based blood pressure reduction: electrical activation of the carotid baroreflex in patients undergoing elective carotid surgery. Vascular. 2007;15(2):63–9.
Scheffers IJ, Kroon AA, Schmidli J, et al. Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study. J Am Coll Cardiol. 2010;56(15):1254–8.
Heusser K, Tank J, Engeli S, et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension. 2010;55(3):619–26.
Krum H, Schlaich M, Sobotka P, Scheffers I, Kroon AA, de Leeuw PW. Novel procedure- and device-based strategies in the management of systemic hypertension. Eur Heart J. 2011;32(5):537–44.
Bisognano JD, Bakris G, Nadim MK, et al. Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol. 2011;58(7):765–73.
Bakris GL, Nadim MK, Haller H, Lovett EG, Schafer JE, Bisognano JD. Baroreflex activation therapy provides durable benefit in patients with resistant hypertension: results of long-term follow-up in the rheos pivotal trial. Am J Hypertens. 2012;6(2):152–8.
Bisognano JD, Kaufman CL, Bach DS, Lovett EG, de Leeuw P. Improved cardiac structure and function with chronic treatment using an implantable device in resistant hypertension: results from European and United States trials of the rheos system. J Am Coll Cardiol. 2011;57(17):1787–8.
Alnima T, de Leeuw PW, Tan FE, Kroon AA. Renal responses to long-term carotid baroreflex activation therapy in patients with drug-resistant hypertension. Hypertension. 2013;61(6):1334–9.
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de Leeuw, P., Kroon, A. (2015). Novel Baroreceptor Activation Therapy. In: Weir, M., Lerma, E. (eds) Chronic Kidney Disease and Hypertension. Clinical Hypertension and Vascular Diseases. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1982-6_8
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DOI: https://doi.org/10.1007/978-1-4939-1982-6_8
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