Faculty Opinions recommendation of Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy: Results of the 6-Year Open Follow-Up.

2017 ◽  
Author(s):  
Tom Lohmeier
Keyword(s):  
Blood Pressure ◽  
Sustained Reduction ◽  
Baroreceptor Activation Therapy ◽  
Activation Therapy ◽  
Baroreceptor Activation

scholarly journals Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

Hypertension ◽  
2017 ◽  
Vol 69 (5) ◽  
pp. 836-843 ◽  
Author(s):  
Peter W. de Leeuw ◽  
John D. Bisognano ◽  
George L. Bakris ◽  
Mitra K. Nadim ◽  
Hermann Haller ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sustained Reduction ◽  
Baroreceptor Activation Therapy ◽  
Activation Therapy ◽  
Baroreceptor Activation

[OP.7A.02] SUSTAINED REDUCTION OF BLOOD PRESSURE WITH BARORECEPTOR ACTIVATION THERAPY

2017 ◽  
Vol 35 ◽  
pp. e63
Author(s):  
P.W. De Leeuw ◽  
J. Bisognano ◽  
G. Bakris ◽  
M. Nadim ◽  
H. Haller ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sustained Reduction ◽  
Baroreceptor Activation Therapy ◽  
Activation Therapy ◽  
Baroreceptor Activation

scholarly journals Smart Baroreceptor Activation Therapy Strikingly Attenuates Blood Pressure Variability in Hypertensive Rats With Impaired Baroreceptor

Hypertension ◽  
2020 ◽  
Vol 75 (3) ◽  
pp. 885-892 ◽  
Author(s):  
Takeshi Tohyama ◽  
Kazuya Hosokawa ◽  
Keita Saku ◽  
Yasuhiro Oga ◽  
Hiroyuki Tsutsui ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Feedback System ◽  
Feedback Mechanism ◽  
Hypertensive Rats ◽  
Hypertensive Patients ◽  
Spontaneously Hypertensive ◽  
Pressure Feedback ◽  
Baroreceptor Activation Therapy ◽  
Activation Therapy ◽  
Baroreceptor Activation

Increased blood pressure (BP) variability (BPV) is an independent risk factor of cardiovascular events among hypertensive patients. The arterial baroreceptor reflex is a powerful regulator of BP and attenuates BPV via a sympathetic negative feedback control. Conventional baroreceptor activation therapy (cBAT) electrically stimulates the carotid baroreceptors with constant stimulation parameters. While cBAT lowers BP, it does not mount a pressure feedback mechanism. We hypothesized that baroreceptor activation therapy with a pressure feedback system (smart BAT [sBAT]) is able to reduce BPV as well as lower BP. We developed sBAT that electrically stimulated baroreceptors at a frequency proportional to the difference between instantaneous BP and a preset reference pressure, and compared its performance with cBAT. In 14-week-old spontaneously hypertensive rats (n=6), we implanted BP telemeter and created impaired arterial baroreceptors by modified sino-aortic denervation. One week after surgical preparation, we administered sBAT, cBAT or no stimulation (sham) for 15 minutes and compared BP and BPV under freely moving condition. Both cBAT and sBAT significantly lowered mean BP (sham, 141.3±12.8; cBAT, 114.3±11.4; and sBAT, 112.0±7.3 mm Hg). Conventional BAT did not affect BPV at all, while sBAT significantly reduced BPV (sham, 15.4±2.6; cBAT, 16.0±5.2; and sBAT, 9.7±3.3 mm Hg). sBAT also prevented transient excessive BP rise and fall. In conclusion, sBAT was capable of reducing BP and attenuating BPV in hypertensive rats with impaired baroreceptor. sBAT is a novel treatment option for hypertensive patients with increased BPV.

scholarly journals Baroreflex activation therapy for resistant hypertension: results from mid-term prospective ambulatory blood pressure registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Sindt ◽  
T Madej ◽  
S Grimm ◽  
M Knaut
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Pressure Drop ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Drug Resistant ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Resistant Arterial Hypertension

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

Interventional Therapies for Resistant Hypertension: A Brief Update

2016 ◽  
Vol 11 (1) ◽  
pp. 65
Author(s):  
Lisa Brandon ◽  
◽  
◽  
Faisal Sharif
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Management Options ◽  
Arteriovenous Shunts ◽  
Significant Difference ◽  
Activation Therapy ◽  
Renal Artery Denervation ◽  
Baroreceptor Activation ◽  
And Control ◽  
Interventional Therapies

Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheterbased renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets – such as baroreceptor activation therapy and arteriovenous shunts – may aid the identification of those patients for whom specific interventional therapies will be effective.

scholarly journals Recent advances in understanding and managing resistant/refractory hypertension

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 169 ◽  
Author(s):  
Michael Doumas ◽  
Konstantinos P Imprialos ◽  
Manolis S Kallistratos ◽  
Athanasios J Manolis
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Uncontrolled Hypertension ◽  
Renal Sympathetic Denervation ◽  
Refractory Hypertension ◽  
European Guidelines ◽  
Carotid Baroreceptor ◽  
Activation Therapy ◽  
Baroreceptor Activation ◽  
Line Drug

The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine.  Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.

Sign in / Sign up

Export Citation Format

Share Document