Carotid Baroreceptor Stimulation, Sympathetic Activity, Baroreflex Function, and Blood Pressure in Hypertensive Patients

Heusser, Karsten; Tank, Jens; Engeli, Stefan; Diedrich, André; Menne, Jan; Eckert, Siegfried; Peters, Tim J.; Sweep, Fred C.G.J.; Haller, Hermann; Pichlmaier, A. M.; Luft, Friedrich C.; Jordan, Jens

doi:10.1161/hypertensionaha.109.140665

Cited by 385 publications

(255 citation statements)

References 42 publications

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“…Thus, there may be some apparent differences in the efficacy of renal denervation compared with BAT, even though both techniques are indicated to reduce sympathetic traffic. 4,11,12 It is conceivable that these differences explain, at least in part, why BAT can still reduce blood pressure in patients who had previous renal denervation. 13 In a small group of predominantly female patients, the initial fall in blood pressure was followed by unresponsiveness to stimulation.…”

Section: Discussionmentioning

confidence: 99%

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

et al. 2017

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Baroreflex activation therapy (BAT) is a novel way of treating hypertensive patients who respond inadequately to medical therapy. After short-term human studies had shown that electric stimulation of the carotid sinus can lower blood pressure, 1,2 the DEBuT-HT study (Device-Based Therapy of Hypertension) demonstrated a substantial and sustained reduction in blood pressure over a period of 3 months in treatment-resistant hypertensive patients.3 Subsequently, the Rheos Pivotal Trial evaluated the effect of BAT in a doubleblind, randomized, prospective, sham-controlled trial in which patients were randomized to receive BAT either immediately or 6 months after implantation of the Rheos device.4 This study also showed that BAT can safely reduce blood pressure in patients with resistant hypertension in the long run. At this point, however, the technique has not yet been introduced into clinical practice. One of the drawbacks is that it is an invasive method, and there is still some concern as to whether efficacy is sustained over longer periods of time. In this regard, the 3 trials that have evaluated this device-based therapy (the US Rheos Feasibility Trial, the DEBuT-HT Trial, and the Rheos Pivotal Trial) offered a unique opportunity to address this problem. Indeed, after the formal completion of both trials, patients were followed up at regular intervals to assess the long-term effect of BAT on blood pressure and heart rate. The purpose of the present report, therefore, is to describe the follow-up results of BAT during a 6-year period. MethodsThe present analyses are based on the group of patients who were included in the US Rheos Feasibility Trial, 2 the DEBuT-HT Trial, 3 and See Editorial Commentary, pp 782-784Abstract-Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term followup data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of followup and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (P<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (P<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (P<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, bu...

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Section: Discussionmentioning

confidence: 99%

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

et al. 2017

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“…It is reasonable to speculate that such intervention to reduce sympathetic overactivity could influence end organ damage. Taking into consideration the promising results of catheter-based renal sympathetic denervation in the treatment of resistant hypertension 29 and newly developed strategies affecting the baroreflex, 30 such speculations considering chemoreflex interventions are not unjustified.…”

Section: Discussionmentioning

confidence: 99%

Tonic activity of carotid body chemoreceptors contributes to the increased sympathetic drive in essential hypertension

et al. 2011

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Carotid chemoreceptors provoke an increase in muscle sympathetic nerve activation (MSNA) in response to hypoxia; they are also tonically active during normoxic breathing. The contribution of peripheral chemoreceptors to sympathetic activation in hypertension is incompletely understood. The aim of our study was to investigate the effect of chemoreceptor deactivation on sympathetic activity in untreated patients with hypertension. A total of 12 untreated hypertensive males and 11 male controls participated in this randomized, crossover, placebo-controlled study. MSNA, systolic blood pressure(BP), diastolic BP, heart rate (HR), electrocardiogram, hemoglobin oxygen saturation (Sat%) and respiratory movements were measured during repeated 10-min periods of respiration with 100% oxygen or 21% oxygen in a blinded fashion. Compared with controls, hypertensives had higher resting MSNA (38±10 vs. 29±0.9 burst per min, Po0.05), systolic BP (150±12 vs. 124±10 mm Hg, Po 0.001) and diastolic BP (92 ± 10 vs. 77 ± 9 mm Hg, Po0.005). Breathing 100% oxygen caused significant decrease in MSNA in hypertensive patients (38 ± 10 vs. 26 ± 8 burst per min and 100 ± 0 vs. 90 ± 10 arbitrary units, Po0.05) and no change in controls (29±9 vs. 27±7 burst per min and 100±0 vs. 96±11 arbitrary units). BP, respiratory frequency and end tidal CO 2 did not change during chemoreceptor deactivation with hyperoxia. HR decreased and Sat% increased in both the study groups. These results confirm the role of tonic chemoreceptor drive in the development of sympathetic overactivity in hypertension.

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“…Chronic baroreflex activation produces sustained decreases in blood pressure 24 and peripheral sympathetic nerve activity. 25 Obesity-induced hypertension in dogs is completely prevented by prior renal denervation. 26 The effects of chronic baroreflex activation and bilateral surgical renal denervation were compared in obesity-induced hypertension.…”

Section: Carotid Baroreflex Activationmentioning

confidence: 99%

Sympathetic Nervous System and Hypertension

2013

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With the development and implementation of device-based therapeutic interventions to decrease renal and systemic nerve activity in patients with resistant hypertension, there has been an increase in research dealing with the role of the sympathetic nervous system in hypertension. These interventions have produced substantial decreases in blood pressure in patients wherein pharmacological treatments, including agents which inhibit the effects of the renin-angiotensin-aldosterone system, have failed serves to confirm and reassert the essential role of the sympathetic nervous system in hypertension. This review will encompass recent publications dealing with the sympathetic nervous system and hypertension, focusing on those recently published in Hypertension. Sympathetic Activation in Animal Models Obesity-Related HypertensionAlthough there has been a debate as to whether sympathetic activation is a cause or consequence of obesity, the studies noted below support the view that it is the obesity that leads to sympathetic activation. The importance of this sympathetic activation for the development of the hypertension is supported by the finding that renal denervation prevents the development of obesity hypertension in the dog.Studies have now focused on the developmental phase of obesity hypertension regarding the renal sympathoexcitation. In rabbits fed high-fat diets, body weight, plasma insulin and leptin concentrations, mean arterial pressure, heart rate, and renal sympathetic nerve activity were all increased after 1 week.1 Mean arterial pressure and body weight continued to increase over 3 weeks of high-fat diet, whereas heart rate and renal sympathetic nerve activity did not change further. Arterial baroreflex control of renal sympathetic nerve activity was attenuated from the first week of the high-fat diet. Excitatory responses to air jet stress diminished over 3 weeks of high-fat diet. Resumption of normal diet normalized glucose, insulin, leptin, and heart rate, but body weight, visceral fat content, mean arterial pressure, and renal sympathetic nerve activity remained elevated. Increased renal sympathetic nerve activity and its impaired baroreflex control, which occur with 1 week of high-fat feeding, seem integral to the rapid development of obesity hypertension. Increased plasma leptin and insulin may contribute to the initiation of hypertension but are not required for maintenance of the hypertension, which is related to the sustained increase in renal sympathetic nerve activity. As the air jet stress response is transduced by hypothalamic neurons, the authors speculate that this site is involved in the maintenance phase of the hypertension with a sustained increase in renal sympathetic nerve activity.The early effects of diet-induced fat accumulation on lumbar sympathetic nerve activity were also examined in rats over 15 days.2 Increases in brown and white adipose tissue (but not body weight) were accompanied by increases in plasma leptin (but not glucose) concentration and heart rate; however, mean a...

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Carotid Baroreceptor Stimulation, Sympathetic Activity, Baroreflex Function, and Blood Pressure in Hypertensive Patients

Cited by 385 publications

References 42 publications

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

Tonic activity of carotid body chemoreceptors contributes to the increased sympathetic drive in essential hypertension

Sympathetic Nervous System and Hypertension

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