Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study

Spiering, Wilko; Williams, Bryan; Heyden, Jan Van der; Kleef, M. van; Lo, Rob T.H.; Versmissen, Jorie; Moelker, Adriaan; Kroon, Abraham A.; Reuter, Hannes; Ansel, Gary M.; Stone, Gregg W.; Bates, Mark C.

doi:10.1016/s0140-6736(17)32337-1

Cited by 105 publications

(63 citation statements)

References 18 publications

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“…Recently, baroreflex activation therapy (BAT), which activates baroreceptors in the carotid sinus by electrostimulation induced by an implantable device (Rheos System, CVRx Inc., Minneapolis, MN, USA), inhibits sympathetic nerve activity, and eventually decreases blood pressure, has drawn attention as a nondrug treatment. BAT was shown to decrease blood pressure 39,40) and BPV 41) in patients with resistant hypertension. BAT also improved BRS and muscle sympathetic nerve activity in patients with chronic heart failure with elevated sympathetic nerve activity.…”

Section: Baroreflex Sensitivity and Variability Of Blood Pressurementioning

confidence: 98%

Clinical Implications of Baroreflex Sensitivity in Type 2 Diabetes

Sakamoto

Matsutani

Kayama³

2019

Int. Heart J.

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The evaluation of baroreflex sensitivity (BRS), which maintains systemic circulatory homeostasis, is an established tool to assess cardiovascular autonomic neuropathy in type 2 diabetes mellitus (T2DM). As BRS plays an important function in blood pressure regulation, reduced BRS leads to an increase in blood pressure variability, which further leads to reduced BRS. This sequence of events becomes a vicious cycle. The major risk factors for reduced BRS are T2DM and essential hypertension, but many other risk factors have been reported to influence BRS. In recent years, reports have indicated that glycemic variability (GV), such as short-and longterm GV that are considered important risk factors for macrovascular and microvascular complications, is involved in reductions in BRS independently of blood glucose levels. In this review, we discuss reduced BRS in T2DM, its features, and the potential for its reversal.(Int Heart J 2019; 60: 241-246)

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Section: Baroreflex Sensitivity and Variability Of Blood Pressurementioning

confidence: 98%

Clinical Implications of Baroreflex Sensitivity in Type 2 Diabetes

Sakamoto

Matsutani

Kayama³

2019

Int. Heart J.

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“…The incidence of serious adverse events (SAEs) and unanticipated device effects (UADEs) at 6 months represented the primary endpoint of these studies. While the CALMFIM_US is still ongoing, no occurrence of UADEs has been registered in the CALMFIM_EUR cohort, which preliminary results are already available (Spiering et al, 2017). Conversely, with respect to SAEs, one patient needed treatment due to dislodgement of the femoral closure device, two because of worsening of hypertension and two for hypotensive crises.…”

Section: Eba Systemmentioning

confidence: 99%

Baroreflex stimulation for treating resistant hypertension: ready for the prime-time?

Bolignano

Coppolino

2019

Rev. Cardiovasc. Med.

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The search of alternative methods for improving clinical management and outcomes of individuals affected by resistant hypertension has become a true health priority. In this review, we aimed at providing a timely overview and evidence synthesis on baroreflex activation therapy (BAT) and endovascular baroreflex amplification (EBA), two device-based therapies which rely on the principle of lowering blood pressure by stimulating the carotid baroreflex to decrease the sympathetic and enhance the parasympathetic activity. In resistant forms of arterial hypertension, accruing evidence has confirmed the capacity of these techniques to improve blood pressure control and to reduce the amount of anti-hypertensive therapy at cost of few side effects. Future results from ongoing randomized sham-controlled trials are eagerly awaited to best define the efficacy, safety and durability of effects in the long term before such an invasive approach may be considered as a suitable option in daily clinical practice.

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“…Similarly, a new technic based on a stent-like device implanted in the carotid to stretch the carotid bulb gave positive preliminary results [107].…”

Section: Carotid Baroreceptor Stimulationmentioning

confidence: 99%

Resistant Hypertension: Novel Insights

Lamirault

Artifoni²,

Daniel

et al. 2020

CHYR

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: Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension. : The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations. : Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management. : In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment. : Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.

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Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study

Abstract: Vascular Dynamics.

Cited by 105 publications

References 18 publications

Clinical Implications of Baroreflex Sensitivity in Type 2 Diabetes

Clinical Implications of Baroreflex Sensitivity in Type 2 Diabetes

Baroreflex stimulation for treating resistant hypertension: ready for the prime-time?

Resistant Hypertension: Novel Insights

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