592SATA Y et al.
Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp classified as a short-term blood pressure control system, 8 carotid baroreflex activation therapy has succeeded in reducing blood pressure in patients with resistant hypertension for more than 1 year, 9 suggesting a potential role of the arterial baroreflex in the long-term regulation of blood pressure. 10 Considering the multifactorial and complex nature of hypertension, further research is needed to understand how sympathetic nerve activity (SNA) and AP are determined in hypertension. The arterial baroreflex system constitutes a key link between the autonomic nervous system and the cardiovascular system. The reflex arc of baroreflex can be divided into 2 principal arcs: the neural arc from pressure input to SNA, and the peripheral arc from SNA to AP. 11,12 Under normal physiological conditions, because the arterial baroreflex operates as a closedloop feedback control system, it is difficult to separately quantify neural and peripheral arc characteristics.The behavior of a system might be described by dynamic and static characteristics. The dynamic characteristics determine he arterial baroreflex control of arterial pressure (AP) is known to reset to a higher input pressure range in hypertension. 1 To cope with the resetting, carotid baroreflex activation is proposed as a potential treatment of drugresistant hypertension. 2,3 Involvement of both neural and cardiovascular factors has been proposed in the pathophysiology of hypertension. Previous studies have demonstrated that sympathetic outflow from the central nervous system is increased in spontaneously hypertensive rats (SHR). 4,5 Peripheral factors such as cardiac hypertrophy and increased vascular resistance are also considered responsible for high AP in SHR. 6 Abnormality in vascular function is also reported in hypertensive patients. 7
Editorial p 510Device-based neuromodulation therapy has increasingly drawn scientific interest. While the arterial baroreflex has been Background: There is ongoing controversy over whether neural or peripheral factors are the predominant cause of hypertension. The closed-loop negative feedback operation of the arterial baroreflex hampers understanding of how arterial pressure (AP) is determined through the interaction between neural and peripheral factors.