Baroreflex device therapy in the treatment of hypertension

Uppuluri, Sarada; Storozynsky, Eugene; Bisognano, John D.

doi:10.1007/s11906-009-0013-x

Cited by 14 publications

(12 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…47 Nonpharmacological interventions include physical training 48 and direct electric stimulation of carotid baroreceptors with an implantable device. 49 …”

Section: Discussionmentioning

confidence: 99%

Baroreflex and Cerebral Autoregulation Are Inversely Correlated

Nasr

Czosnyka

Traon

et al. 2014

Circ J

View full text Add to dashboard Cite

“…47 Nonpharmacological interventions include physical training 48 and direct electric stimulation of carotid baroreceptors with an implantable device. 49 …”

Section: Discussionmentioning

confidence: 99%

Baroreflex and Cerebral Autoregulation Are Inversely Correlated

Nasr

Czosnyka

Traon

et al. 2014

Circ J

View full text Add to dashboard Cite

“…Ongoing trials on these devices are finding significant and sustained reductions in blood pressure, a good safety profile, and tolerable side effects. 68 However, the evidence is insufficient to draw further conclusions, in particular regarding acute stroke therapy.…”

Section: Baroreflex Modulation: a New Therapeutic Target In Stroke?mentioning

confidence: 99%

Baroreflex: A New Therapeutic Target in Human Stroke?

Sýkora

Diedler

Turčãni

et al. 2009

Stroke

101

View full text Add to dashboard Cite

Background and Purpose-Autonomic dysfunction, including increased sympathetic drive and blunted baroreflex, has repeatedly been observed in acute stroke. Of clinical importance is that the stroke-related autonomic imbalance seems to be linked to worse outcome after stroke. Here, we discuss the role of baroreflex impairment in acute stroke and its possible pathophysiological and therapeutic relevance. Summary of Review-Possible mechanisms linking baroreflex impairment with unfavorable outcome in stroke may include increased cardiovascular morbidity and mortality, promotion of secondary brain injury due to local inflammation, hyperglycemia, or altered cerebral perfusion. Conclusions-We suggest therefore that the modifying of autonomic functions may have important therapeutic implications in acute ischemic as well as in hemorrhagic stroke. (Stroke. 2009;40:e678-e682.)

show abstract

“…However, interventions with curative potential have recently started to dominate the literature. If their popularity were assessed in terms of published data and reviews, these procedures may be ranked as, firstly, renal sympathetic denervation (RDN); secondly, carotid baroreflex activation therapy (BAT); and thirdly renal arteriovenous fistula (RAVF) …”

Section: Three Interventional Techniques Of Current Interestmentioning

confidence: 99%

Diagnosis and Treatment of Resistant Hypertension: The Critical Role of Ambulatory Blood Pressure Monitoring

Turner

O’Brien

2013

J of Clinical Hypertension

View full text Add to dashboard Cite

Hypertension is an illness that generally requires lifelong treatment with blood pressure (BP)-lowering drugs. It is, therefore, understandable that increasing attention is being paid to interventional procedures that might provide a "cure" for hypertension and obviate the need for costly therapy that is not always without unwanted effects. Such interventional techniques are confined, for the moment, to patients with drug-resistant hypertension, ie, BP levels above a specified target despite adherence to at least 3 optimally dosed antihypertensive medications of different classes, including a diuretic, 1,2 to which we would add for a minimum of 3 months on such maximal treatment.In clinical research involving these procedures (as for research involving pharmaceutical therapies), two key aspects of a given trial's design merit particular attention: verification that individuals enrolled in the trial truly have drug-resistant hypertension and that there is no underlying cause for hypertension (ie, secondary hypertension); and the choice of BP endpoints to be assessed at specified timepoints following surgical interventions. There are now various measurement methodologies available to us with which to obtain BP data in both contexts, ie, as inclusion/exclusion criteria for entry into the trial and as measures of the intervention's efficacy. A question we must ask in both settings is: What is the most informative way we can assess BP? We believe the answers are uniform and clear: ambulatory BP monitoring (ABPM) is the most appropriate and informative methodology and should be mandatory in all studies to investigate interventional efficacy. TWO BP MEASUREMENT METHODOLOGIESConventional clinical BP measurement (CBPM) in a physician's office or at an investigational site during pharmacologic trials traditionally utilized the auscultatory technique that is more than 100 years old, although, recently, trials have used automated devices to measure BP. 3 While we believe that the auscultatory technique is inherently accurate, "it is dependent on observer attention to detail, which is often lacking, and it provides only a momentary measurement of BP, usually under circumstances that can influence the level of BP being measured."4 Moreover, even though automated techniques may improve accuracy, 5 the BP-measuring process is seriously flawed by providing only a snapshot of BP under circumstances that may elevate BP. For example, the phenomenon of white-coat hypertension, 6 in which an individual demonstrates higher BP levels in a physician's office or clinic than in other settings, is problematic when using CBPM (as is masked hypertension, the phenomenon of appearing normotensive in the office but having hypertension in other settings). 7Two arguments can reasonably be postulated. First, if participants in a clinical trial of a procedural intervention have been enrolled based on CBPM values that were indeed influenced by the white-coat phenomenon and then undergo the intervention, their true (lower) BP values are less likely t...

show abstract

Baroreflex device therapy in the treatment of hypertension

Cited by 14 publications

References 25 publications

Baroreflex and Cerebral Autoregulation Are Inversely Correlated

Baroreflex and Cerebral Autoregulation Are Inversely Correlated

Baroreflex: A New Therapeutic Target in Human Stroke?

Diagnosis and Treatment of Resistant Hypertension: The Critical Role of Ambulatory Blood Pressure Monitoring

Contact Info

Product

Resources

About