Baroreflex activation therapy in patients with end-stage renal failure

Beige, Joachim; Koziolek, Michael; Hennig, G.; Hamza, Amir; Wendt, Ralph T.; Müller, Gerhard A.; Wallbach, Manuel

doi:10.1097/hjh.0000000000000697

Cited by 18 publications

(8 citation statements)

References 32 publications

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“…ABP also showed a decrease in SBP and DBP from 167 ±30 mmHg (SBP) and 94 ±24 mmHg (DBP) to 134 ±27 mmHg (SBP) and 79 ±22 mmHg (DBP). However, due to the limited number of patients, this decrease both for SBP and DBP was not significant [25].…”

Section: Carotid Sinus Stimulationmentioning

confidence: 79%

“…As hypertension is frequently associated with renal impairment and BAT seems to have a nephroprotective effect [24], Beige et al [25] studied whether patients with end-stage renal failure benefit from BAT. In 6 patients, who were enrolled in other prospective BAT studies with BAROSTIM NEO®, the office SBP after 12 months decreased significantly from 194 ±28 to 137 ± 16 mmHg.…”

Section: Carotid Sinus Stimulationmentioning

confidence: 99%

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Implant-Mediated Therapy of Arterial Hypertension

2020

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Purpose of Review To give an overview on recent developments in permanent implant-based therapy of resistant hypertension. Recent Findings The American Heart Association (AHA) recently updated their guidelines to treat high blood pressure (BP). As elevated BP now is defined as a systolic BP above 120 mmHg, the prevalence of hypertension in the USA has increased from 32% (old definition of hypertension) to 46%. In the past years, device-and implant-mediated therapies have evolved and extensively studied in various patient populations. Despite an initial drawback in a randomized controlled trial (RCT) of bilateral carotid sinus stimulation (CSS), new and less invasive and unilateral systems for baroreflex activation therapy (BAT) with the BAROSTIM NEO® have been developed which show promising results in small non-randomized controlled (RCT) studies. Selective vagal nerve stimulation (VNS) has been successfully evaluated in rodents, but has not yet been tested in humans. A new endovascular approach to reshape the carotid sinus to lower BP (MobiusHD™) has been introduced (baroreflex amplification therapy) with favorable results in non-RCT trials. However, long-term results are not yet available for this treatment option. A specific subgroup of patients, those with indication for a 2-chamber cardiac pacemaker, may benefit from a new stimulation paradigm which reduces the AV latency and therefore limits the filling time of the left ventricle. The most invasive approach for resistant hypertension still is the neuromodulation by deep brain stimulation (DBS), which has been shown to significantly lower BP in single cases. Summary Implant-mediated therapy remains a promising approach for the treatment of resistant hypertension. Due to their invasiveness, such treatment options must prove superiority over conventional therapies with regard to safety and efficacy before they can be generally offered to a wider patient population. Overall, BAROSTIM NEO® and MobiusHD™, for which large RCTs will soon be available, are likely to meet those criteria and may represent the first implant-mediated therapeutical options for hypertension, while the use of DBS probably will be reserved for individual cases. The utility of VNS awaits appropriate assessment.

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Section: Carotid Sinus Stimulationmentioning

confidence: 79%

Section: Carotid Sinus Stimulationmentioning

confidence: 99%

Implant-Mediated Therapy of Arterial Hypertension

2020

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“…They found a mean office BP fall of 17/9 mmHg as compared to 1/1 mmHg fall in 21 patients in the control group (standard medical management) after 6 months (p < 0.01) [31]. Beige et al investigated the effect of baroreflex activation therapy in seven patients with end-stage renal disease and RH [32]. They found a significant decrease in office systolic BP from 194 ± 28 to 137 ± 16 mmHg (p < 0.01).…”

Section: Electrical Baroreflex Amplificationmentioning

confidence: 99%

Baroreflex Amplification and Carotid Body Modulation for the Treatment of Resistant Hypertension

Groenland

Spiering

2020

Curr Hypertens Rep

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Purpose of Review Patients with true resistant hypertension (RH) are characterized by having high sympathetic activity and therefore potentially benefit from treatments such as baroreflex amplification (baroreflex activation therapy (BAT) or endovascular baroreflex amplification therapy (EVBA)) or carotid body (CB) modulation. This review aims at providing an up-to-date overview of the available evidence regarding these two therapies. Recent Findings In recent years, increasing evidence has confirmed the potential of baroreflex amplification, either electrically (Barostim neo) or mechanically (MobiusHD), to improve blood pressure control on short-and long-term with only few side effects, in patients with RH. Two studies regarding unilateral CB resection did not show a significant change in blood pressure. Only limited studies regarding CB modulation showed promising results for transvenous CB ablation, but not for unilateral CB resection. Summary Despite promising results from mostly uncontrolled studies, more evidence regarding the safety and efficacy from ongoing large randomized sham-controlled trials is needed before baroreflex amplification and CB modulation can be implemented in routine clinical practice.

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“…Particularly interesting for CKD patients is that BAT was not only shown to decrease office BP values in small prospective trials on CKD non-dialysis and dialysis patients [47, 48], but also to have renoprotective effects by significantly reducing proteinuria and improving eGFR [47]. BAT would be an option when RD is not possible or inefficient [49].…”

Section: Haemorrhagic Strokementioning

confidence: 99%

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

Bîlha¹,

Burlacu²,

Siriopol³

et al. 2018

Cerebrovasc Dis

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Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking. Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe in non-end stage CKD, but it should be individualized and preferably based on thromboembolic and bleeding stratification algorithms. Non-vitamin K antagonist oral anticoagulants with definite dose adjustment are generally preferred over vitamin K antagonists in mild and moderate CKD and their indications have started being extended to severe CKD and dialysis also. Aspirin, but not clopidogrel, has limited indications for reducing the risk for atherothrombotic events in CKD due to its increased bleeding risk. Carotid endarterectomy has shown promising results for stroke risk reduction in CKD patients with high-grade symptomatic carotid stenosis. The medical treatment of arterial hypertension in CKD often fails to efficiently lower blood pressure values, but recent data regarding the use of interventional procedures such as renal denervation, baroreflex activation therapy or renal artery stenting are encouraging. Key Messages: In the absence of clear guidelines and protocols, primary prevention of stroke in CKD patients remains a subtle art in the hands of the clinicians. Nevertheless, refraining CKD patients from standard therapies often worsens their prognosis.

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Baroreflex activation therapy in patients with end-stage renal failure

Abstract: BAT is an effective and well tolerated intervention to reduce BP in patients suffering from end-stage renal disease and resistant hypertension. Therefore, BAT might contribute to a reduction of cardiovascular events in those high-risk patients.

Cited by 18 publications

References 32 publications

Implant-Mediated Therapy of Arterial Hypertension

Implant-Mediated Therapy of Arterial Hypertension

Baroreflex Amplification and Carotid Body Modulation for the Treatment of Resistant Hypertension

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

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