Baroreflex Activation Therapy in Resistant Arterial Hypertension: Results from Updated Prospective Ambulatory Blood Pressure Follow-up Registry

Abstract Objectives First generation baroreflex activation therapy (BAT) devices showed clinical efficacy in patients with drug-resistant arterial hypertension (AHT), but the safety profile was insufficient. Data regarding efficacy of second-generation devices were generated mostly from office blood pressure (BP) measurements or short-term 24-hour ambulatory blood pressure measurements (ABPM). We present a mid-term prospective registry to evaluate the efficacy and safety of recent BAT devices. Purpose The purpose of our study was to find a method that helps patients with drug-resistant arterial hypertension to control their blood pressure. Further we sought to reduce the overall amount of antihypertensive drugs to lessen side effects, as well as the effects of polypharmacy. Methods All patients receiving Barostim neo between November 2013 and June 2019 for resistant AHT were prospectively included into this observational study. ABPM was performed at baseline, in 3-month intervals in the first year after BAT implantation and in 6-month intervals afterwards for up to 42 months. Patients were assigned into two groups of responders and non-responders. Non-responders had a mean blood pressure drop (BPD) below 5mmHg. Responders in turn were categorized into 3 sub-groups (low-BPD between 5–9 mmHg, medium-BPD between 10–19 mmHg and high-BPD ≥20 mmHg). The primary efficacy end-points were changes in systolic and diastolic BP and number of antihypertensive medications. The primary safety end point was BAT-related major adverse events (MAE). Results 64 patients (mean age 63 years, 67% males) were included. Only patients who completed a 24-hour ABPM during a follow up were counted in the statistical analysis. We had an overall responder rate of 67.8%. Out of those 15.4% had low-BPD, 38.4% medium-BPD and 46.2% had a high-BPD. Systolic BP decreased over the 3.5-years period from 168±17 mmHg to 149±19 mmHg (n=19, mean change −18.8 mmHg; 95% confidence interval [CI]: −29.32 to −8.36; p<0.0007). Diastolic BP decreased from 97±16 to 85±12 mmHg (n=19, mean change −11.7 mmHg; 95% CI: −19.2 to −4.2; p<0.0021). The mean number of antihypertensive drugs was reduced from 6.9±1.3 to 5.2±1.5 (n=19, mean change −1.7; 95% CI: −0.8 to −0.27; p<0.0009). The time course of primary end-points is shown in Fig.1. Freedom from BAT-related MAE was 93.5%. 4 perioperative complications (1 pocket bleeding, 1 pocket infection, 1 N. hypoglossus palsy, 1 hoarseness) resolved without residual side effects. There were five non BAT related deaths (7,8%) in the follow up period. Conclusion Systolic and diastolic ABP, as well as number and dosage of antihypertensive drugs decreased significantly during 3.5-years follow-up after Barostim neo implantation in 64 consecutive patients (of whom 62 completed at least one follow-up). No MAE associated with BAT were observed after the perioperative period. However, further controlled trials are needed to confirm the long-term efficacy of BAT. Figure 1. Mean blood pressure drop Funding Acknowledgement Type of funding source: None

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Baroreflex Activation Therapy Effectively Reduces Drug-Resistant Arterial Hypertension in Mid- Term Follow-Up

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1598892 ◽

2017 ◽

Vol 65 (S 01) ◽

pp. S1-S110

Author(s):

T. Madej ◽

T. Schmidt ◽

K. Matschke ◽

M. Knaut

Keyword(s):

Arterial Hypertension ◽

Drug Resistant ◽

Baroreflex Activation Therapy ◽

Activation Therapy ◽

Resistant Arterial Hypertension

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Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

Clinical Cardiology ◽

10.1002/clc.22269 ◽

2014 ◽

Vol 37 (5) ◽

pp. 307-311 ◽

Cited By ~ 10

Author(s):

Thomas Lambert ◽

Hermann Blessberger ◽

Verena Gammer ◽

Alexander Nahler ◽

Michael Grund ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Ambulatory Blood Pressure ◽

Renal Denervation ◽

Pressure Measurements ◽

Resistant Arterial Hypertension ◽

Ambulatory Blood Pressure Measurements

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Abstract P255: Resistance Hypertension And Achievement Of Target Blood Pressure Level By Continuous Positive Airway Pressure Long Therapy In Patients With Obstructive Sleep Apnea

Hypertension ◽

10.1161/hyp.78.suppl_1.p255 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Oksana Rekovets ◽

Yuriy Sirenko ◽

Nina Krushynska ◽

Olena Torbas ◽

Svitlana Kushnir ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Arterial Hypertension ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

Resistant Arterial Hypertension

The aim was to assess the arterial stiffness changes in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy. Design: In 10 month follow-up study were included 46 patients with RAH, who were divided into groups: 1-st - patients with RAH and moderate to severe OSA on CPAP (n=21); 2-nd - patients with RAH and moderate to severe OSA without CPAP (n=25). They underwent somnography by dual-channel portable monitor device, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. All patients received similar antihypertensive therapy according to 2013 ESH Guidelines for the management of arterial hypertension. Results: Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event h-1) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event h-1) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg m-2, P<0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg dl-1, P<0,05)). Patients with RAH and OSA in comparison with patients with RAH without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m s-1, P<0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P<0,05). During 10 months follow-up in patients with RAH and moderate and sever OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.1±0.5 to 10.5±0.5 m s-1, P<0,05), decrease office systolic blood pressure (from 147.8±3.7 to 136.7±2.8 mm Hg; P<0,05) and diastolic blood pressure (from 96.8±3.5 to 87.0±3.3 mm Hg; P<0,05) with achievement of target levels in 67,2% patients. Central systolic BP decreased (from 143.8±2.7 to 137.7±2.8 mm Hg; P<0,05). Conclusion: The combination of therapy continuous positive airway pressure with antihypertensive treatment in patients with resistant arterial hypertension and moderate to severe obstructive sleep apnea improved achievement of target blood pressure, decreased arterial stiffness and decreased central blood pressure.

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Renal denervation with a resistant arterial hypertension: the results of a five-year follow-up

Terapevticheskii arkhiv ◽

10.26442/terarkh201890988-91 ◽

2018 ◽

Vol 90 (9) ◽

pp. 88-91 ◽

Cited By ~ 1

Author(s):

P V Glybochko ◽

A A Svetankova ◽

A V Rodionov ◽

A S Maltseva ◽

V A Sulimov ◽

...

Keyword(s):

Quality Of Life ◽

Blood Pressure ◽

Arterial Hypertension ◽

Kidney Function ◽

Renal Denervation ◽

Quality Of Life Indicators ◽

Before And After ◽

Resistant Arterial Hypertension

Aim. To evaluate the 5-year results of renal denervation (RDN) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 14 patients to whom, during the 2011-2013 period RDN has been completed. Before and after the intervention, office blood pressure, quality of life indicators according to the EQ-5D questionnaire, mass index bodies, indicators of kidney function were duly assessed. Results. Five years after RDN, office BP decreased from 165/110 to 139/95 mm Hg. Art. (p

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