scholarly journals The Current Status of Devices for the Treatment of Resistant Hypertension

2019 ◽  
Vol 33 (1) ◽  
pp. 10-18
Author(s):  
Michael Kunz ◽  
Lucas Lauder ◽  
Sebastian Ewen ◽  
Michael Böhm ◽  
Felix Mahfoud
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Treatment Options ◽  
Pressure Control ◽  
Current Status ◽  
Baroreflex Activation Therapy ◽  
Major Cardiovascular Events ◽  
Cardiovascular Morbidity And Mortality ◽  
Treatment Of Hypertension ◽  
Activation Therapy

Abstract Arterial hypertension is associated with increased cardiovascular morbidity and mortality. Although blood pressure-lowering therapies significantly reduce the risk of major cardiovascular events, blood pressure control remains unsatisfactorily low. Several device-based antihypertensive therapies have been investigated in patients with treatment-resistant hypertension and in patients unable or unwilling to adhere to antihypertensive medication. As the field of device-based therapies is subject to constant change, this review aims at providing an up-to-date overview of different device-based approaches for the treatment of hypertension. These approaches target the sympathetic nervous system (renal denervation, baroreflex amplification therapy, baroreflex activation therapy, and carotid body ablation) or alter mechanical arterial properties by creating an iliac arteriovenous fistula. Notably, the use of all of these treatment options is not recommended for the routine treatment of hypertension by current guidelines but should be investigated in the context of controlled clinical studies.

Device Therapy of Hypertension

2021 ◽  
Vol 128 (7) ◽  
pp. 1080-1099
Author(s):  
Felix Mahfoud ◽  
Markus P. Schlaich ◽  
Melvin D. Lobo
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Blood Pressure Control ◽  
Carotid Body ◽  
Renal Denervation ◽  
Pressure Control ◽  
Hypertension Control ◽  
Baroreflex Activation Therapy ◽  
Improve Blood Pressure Control ◽  
Activation Therapy

In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.

Acute on/off effects and chronic blood pressure reduction after long-term baroreflex activation therapy in resistant hypertension

2015 ◽  
Vol 33 (8) ◽  
pp. 1697-1703 ◽  
Author(s):  
Marcel Halbach ◽  
Tilman Hickethier ◽  
Navid Madershahian ◽  
Hannes Reuter ◽  
Mathias C. Brandt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy

scholarly journals Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension

Hypertension ◽  
2016 ◽  
Vol 67 (4) ◽  
pp. 701-709 ◽  
Author(s):  
Manuel Wallbach ◽  
Luca-Yves Lehnig ◽  
Charlotte Schroer ◽  
Stephan Lüders ◽  
Enrico Böhning ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Resistant Hypertension ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy

scholarly journals Baroreflex Activation Therapy Lowers Blood Pressure in Patients With Resistant Hypertension

2011 ◽  
Vol 58 (7) ◽  
pp. 765-773 ◽  
Author(s):  
John D. Bisognano ◽  
George Bakris ◽  
Mitra K. Nadim ◽  
Luis Sanchez ◽  
Abraham A. Kroon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy

New Hope for Resistant Hypertention

2012 ◽  
Vol 5 (1) ◽  
pp. 81-91
Author(s):  
Z Rahman ◽  
KK Karmaker ◽  
M Ahmed ◽  
M Aziz ◽  
S Chowdhury ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Patient Adherence ◽  
Public Health Problem ◽  
Drug Regimen ◽  
Renal Sympathetic Denervation ◽  
Major Public Health Problem ◽  
Antihypertensive Medications ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Increasing Trends

Hypertension is a major public health problem. Despite the increasing awareness of hypertension and its implications among patients and treating physicians, the prevalence of resistant hypertension    remains high.Resistant hypertension define as blood pressure that remains elevated above treatment goals despite administration of an optimal three drug regimen that include a diuretic1 The prevalence of resistant    hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. It is estimated that at least 10% of all patients with hypertension are resistant to existing drugs. Management of resistant hypertension must begin with  a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with “pseudo-resistance,” such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Despite the use of the appropriate dose and type of diuretic to overcome the management of resistant hypertension, we can’t achieve our goal. But there is at least two devices namely Baroreflex Activation Therapy and Catheter-based  renal sympathetic denervation make the new hope for the patient with resistant hypertension DOI: http://dx.doi.org/10.3329/cardio.v5i1.12278 Cardiovasc. j. 2012; 5(1): 81-91

Sign in / Sign up

Export Citation Format

Share Document