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Congestive heart failure is characterized by hemodynamic and non-hemodynamic abnormalities, the latter including an activation of the sympathetic influences to the heart and peripheral circulation coupled with an impairment of baroreceptor control of autonomic function. Evidence has been provided that both these alterations are hallmark features of the disease with a specific relevance for the disease progression as well as for the development of life-threatening cardiac arrhythmias. In addition, a number of studies have documented in heart failure the adverse prognostic role of the sympathetic and baroreflex alterations, which both are regarded as major independent determinants of cardiovascular morbidity and mortality. This represents the pathophysiological and clinical background for the use of carotid baroreceptor activation therapy in the treatment of congestive heart failure. Promising data collected in experimental animal models of heart failure have supported the recent performance of pilot small-scale clinical studies, aimed at providing initial information in this area. The results of these studies demonstrated the clinical safety and efficacy of the intervention which has been tested in large-scale clinical studies. The present paper will critically review the background and main results of the published studies designed at defining the clinical impact of baroreflex activation therapy in congestive heart failure patients. Emphasis will be given to the strengths and limitations of such studies, which represent the background for the ongoing clinical trials testing the long-term effects of the device in heart failure patients.

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Blood pressure measurement and arterial stiffness / Endothelial function and the microcirculation 51been poorly understood. We hypothesized that aortic stiffness, representing vascular aging, may be involved in the development of OH. Purpose: The aim of this study was to investigate the association between central haemodynamic parameters and OH. Methods: A total of 200 patients (age 64.3±10.9 years, 62.5% male) who underwent invasive coronary angiography (ICA) was prospectively recruited. OH was assessed using blood pressure measurements in the supine and standing position. Haemodynamic parameters were measured at the ascending aorta using a pig-tail catheter immediately before coronary angiography. Results: OH was present in 62 subjects (31.0%). Diabetes mellitus was more prevalent in patients with OH than those without (46.8% versus 23.2%, P=0.001).Other clinical parameters including age, cardiovascular risk factors, laboratory findings and concomitant medications were not different between patients with and without OH (P>0.05 for each). Aortic systolic blood pressure, aortic mean arterial pressure, aortic pulse pressure, fractional pulse pressure, pulsatility index were significantly higher in patients with OH than those without OH (P<0.05 for each). Using receiver operating characteristic curve analysis we found best cut-off values for predicting OH. In multivariable analysis, higher aortic systolic pressure, aortic pulse pressure, fractional pulse pressure, pulsatility index were independently associated with OH even after controlling for potential confounders (P<0.05 for each).