Truly Refractory Hypertension

Schroeder, Christoph; Heusser, Karsten; Brinkmann, Julia; Menne, Jan; Oswald, Hanno; Haller, Hermann; Jordan, Jens; Tank, Jens; Luft, Friedrich C.

doi:10.1161/hypertensionaha.113.01240

Cited by 11 publications

(10 citation statements)

References 24 publications

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“…25 Therefore, among patients with resistant hypertension a certain proportion of true non-responders to a treatment reducing sympathetic activity can be expected. 26 However, in our patients the overall acute response to stimulation that was tolerable in the long term was surprisingly small and more than a third of patients did not respond at all. While we observed non-responders in our previous study applying bilateral bipolar electrical carotid sinus stimulation, 7 reductions in BP and MSNA were more robust.…”

Section: Discussioncontrasting

confidence: 49%

Acute Response to Unilateral Unipolar Electrical Carotid Sinus Stimulation in Patients With Resistant Arterial Hypertension

et al. 2016

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Bilateral bipolar electrical carotid sinus stimulation acutely reduced muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in patients with resistant arterial hypertension but is no longer available. The second-generation device utilizes a smaller unilateral unipolar disk electrode to reduce invasiveness while saving battery life. We hypothesized that the second-generation device acutely lowers BP and MSNA in treatment-resistant hypertensive patients. Eighteen treatment-resistant hypertensive patients (9 women/9 men, 53±11 years, 33±5 kg/m2) on stable medications have been included in the study. We monitored finger and brachial BP, heart rate (HR), and MSNA. Without stimulation, BP was 165±31/91±18 mmHg, HR was 75±17 bpm, and MSNA was 48±14 bursts/min. Acute stimulation with intensities producing side effects that were tolerable in the short term elicited interindividually variable changes in systolic BP (SBP: −16.9±15.0 mmHg, range: 0.0 to −40.8 mmHg, p=0.002), HR (−3.6±3.6 bpm, p=0.004), and MSNA (−2.0±5.8 bursts/min, p=0.375). Stimulation intensities had to be lowered in 12 patients to avoid side effects at the expense of efficacy (SBP: −6.3±7.0 mmHg, range: 2.8 to −14.5 mmHg, p=0.028; HR: −1.5±2.3 bpm, p=0.078; comparison against responses with side effects). Reductions in diastolic BP and MSNA (total activity) were correlated (r2=0.329, p=0.025). In our patient cohort, unilateral unipolar electrical baroreflex stimulation acutely lowered BP. However, side effects may limit efficacy. The approach should be tested in a controlled comparative study.

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Section: Discussioncontrasting

confidence: 49%

Acute Response to Unilateral Unipolar Electrical Carotid Sinus Stimulation in Patients With Resistant Arterial Hypertension

et al. 2016

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“…Auch könnten erhöhte Aldosteronspiegel bei normalem Reninspiegel eine Rolle spielen [7]. Vor 30 Jahren führten Swales [8] [9]. Sowohl diagnostisch als auch therapeutisch haben wir bei unserer Patientin alles versucht und dennoch keine befriedigende Blutdruckeinstellung erreicht [14].…”

Section: Abstract | Medication Adherence -Hypertension Secondary -Whunclassified

“…MSNA "Muscle sympathetic nerve activity". (Adaptiert nach [9]; mit freundl. Genehmigung von American Heart Association/Wolters Kluwer Health -Lippincott Williams & Wilkins)…”

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Resistente Hypertonie

Luft

2015

Internist

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“…The patient was also taking, daily, 12 other medications related to the treatment of angina (ivabradine), chronic nerve pain (600-mg pregabalin, 400-mg flupirtine, and 60-mg morphine), epilepsy (400-mg lamotrigine and 200-mg zonisamide), allergies, cholesterol (10-mg ezetimibe and 40-mg simvastatin), and vitamin supplements. Adherence to medication had previously been confirmed by urine analysis, 2 and deviation from this compliance was highly unlikely given the patient's proactive attitude to her own health and dedication to maintaining her home BP records.…”

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confidence: 96%

“…A secondary cause of her hypertension has yet to be found, despite having been thoroughly investigated by hypertension specialists in Germany at the Hannover Medical School and Experimental and Clinical Research Center, Charité Berlin-Buch. 2 Evidence for the following causes of hypertension was absent: pheochromocytoma, renin-angiotensin-aldosterone disorders, obstructive sleep apnea, cerebral vessel abnormalities, and Mendelian syndromes. Her arterial stiffness was high (11.5 m/s), as measured by pulse wave velocity; however, this is within the expected range for the European population in her age group and BP category (50-59 years; BP ≥160/100 mm Hg; pulse wave velocity mean [±SD], 8.8 [4.8-12.8]).…”

mentioning

confidence: 99%