Baroreflex activation therapy in patients with prior renal denervation

Wallbach, Manuel; Halbach, Marcel; Reuter, Hannes; Passauer, Jens; Lüders, Stephan; Böhning, Enrico; Zenker, Dieter; Müller, Gerhard A.; Wachter, Rolf; Koziolek, Michael

doi:10.1097/hjh.0000000000000949

Cited by 29 publications

(20 citation statements)

References 46 publications

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“…However, one of the more surprising experimental observations is that the presence of renal nerves is not an obligate requirement for chronically reducing blood pressure during baroreflex activation (20). Consistent with this finding, chronic baroreflex activation reduced blood pressure in patients in whom catheterbased renal nerve ablation was unsuccessful in treating their hypertension (13,35).…”

Section: Introductionmentioning

confidence: 87%

Role of the heart in blood pressure lowering during chronic baroreflex activation: insight from an in silico analysis

Clemmer

Pruett

Hester

et al. 2018

American Journal of Physiology-Heart and Circulatory Physiology

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Electrical stimulation of the baroreflex chronically suppresses sympathetic activity and arterial pressure and is currently being evaluated for the treatment of resistant hypertension. The antihypertensive effects of baroreflex activation are often attributed to renal sympathoinhibition. However, baroreflex activation also decreases heart rate, and robust blood pressure lowering occurs even after renal denervation. Because controlling renal sympathetic nerve activity and cardiac autonomic activity cannot be achieved experimentally, we used an established mathematical model of human physiology (HumMod) to provide mechanistic insight into their relative and combined contributions to the cardiovascular responses during baroreflex activation. Three week responses to baroreflex activation closely mimicked experimental observations in dogs including decreases in blood pressure, heart rate, and plasma norepinephrine, and increases in plasma atrial natriuretic peptide, providing validation of the model. Simulations showed that baroreflex-induced alterations in cardiac sympathetic and parasympathetic activity lead to sustained depression of cardiac function and increased secretion of atrial natriuretic peptide. Increased atrial natriuretic peptide and suppression of renal sympathetic nerve activity both enhanced renal excretory function and accounted for most of the chronic blood pressure lowering during baroreflex activation. However, when suppression of renal sympathetic nerve activity was blocked, the blood pressure response to baroreflex activation was not appreciably impaired due to inordinate fluid accumulation and further increases in atrial pressure and atrial natriuretic peptide secretion. These simulations provide a mechanistic understanding of experimental and clinical observations showing that baroreflex activation effectively lowers blood pressure in subjects with previous renal denervation.

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Section: Introductionmentioning

confidence: 87%

Role of the heart in blood pressure lowering during chronic baroreflex activation: insight from an in silico analysis

Clemmer

Pruett

Hester

et al. 2018

American Journal of Physiology-Heart and Circulatory Physiology

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“…In 2016, Wallbach et al published a non-randomized retrospective investigation of 28 patients who had uncontrolled hypertension despite previous renal denervation at least 5 months before [26]. After 6 and 12 months, office SBP was significantly reduced by 18/21 mmHg, while office DBP showed a nonsignificant decrease of 5/5 mmHg.…”

Section: Carotid Sinus Stimulationmentioning

confidence: 99%

Implant-Mediated Therapy of Arterial Hypertension

2020

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Purpose of Review To give an overview on recent developments in permanent implant-based therapy of resistant hypertension. Recent Findings The American Heart Association (AHA) recently updated their guidelines to treat high blood pressure (BP). As elevated BP now is defined as a systolic BP above 120 mmHg, the prevalence of hypertension in the USA has increased from 32% (old definition of hypertension) to 46%. In the past years, device-and implant-mediated therapies have evolved and extensively studied in various patient populations. Despite an initial drawback in a randomized controlled trial (RCT) of bilateral carotid sinus stimulation (CSS), new and less invasive and unilateral systems for baroreflex activation therapy (BAT) with the BAROSTIM NEO® have been developed which show promising results in small non-randomized controlled (RCT) studies. Selective vagal nerve stimulation (VNS) has been successfully evaluated in rodents, but has not yet been tested in humans. A new endovascular approach to reshape the carotid sinus to lower BP (MobiusHD™) has been introduced (baroreflex amplification therapy) with favorable results in non-RCT trials. However, long-term results are not yet available for this treatment option. A specific subgroup of patients, those with indication for a 2-chamber cardiac pacemaker, may benefit from a new stimulation paradigm which reduces the AV latency and therefore limits the filling time of the left ventricle. The most invasive approach for resistant hypertension still is the neuromodulation by deep brain stimulation (DBS), which has been shown to significantly lower BP in single cases. Summary Implant-mediated therapy remains a promising approach for the treatment of resistant hypertension. Due to their invasiveness, such treatment options must prove superiority over conventional therapies with regard to safety and efficacy before they can be generally offered to a wider patient population. Overall, BAROSTIM NEO® and MobiusHD™, for which large RCTs will soon be available, are likely to meet those criteria and may represent the first implant-mediated therapeutical options for hypertension, while the use of DBS probably will be reserved for individual cases. The utility of VNS awaits appropriate assessment.

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“…Although renal function did not differ, interestingly, albuminuria fell significantly as well. This suggests that those who "fail" one form of device therapy may benefit from a different approach [28].…”

Section: Carotid Sinus Baroreceptor Electrical Stimulatorsmentioning

confidence: 99%

Treatment of Resistant Hypertension: An Update in Device Therapy

Quinn¹,

Gary²,

Damiano³

et al. 2018

Blood Pressure - From Bench to Bed

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Hypertension is the most prevalent cardiac risk factor. In the United some estimates show 60% of 60-year-olds, 70% of 70-year-olds, an 80% of 80-year-olds being hypertensive. Often, blood pressure becomes resistant or refractory. Device therapy represents a new approach to treating this disease. The best studied of these nonpharmacologic approaches to resistant/refractory hypertension include renal denervation, carotid sinus stimulators, and central arteriovenous fistula placement. This chapter will focus on novel device therapy and literature review of its use in clinical trials.

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Baroreflex activation therapy in patients with prior renal denervation

Abstract: The present data demonstrate that BAT may exert BP-lowering as well as antiproteinuric effects in patients with prior renal denervation. However, precise evaluation of BAT effects in patients with prior renal denervation will need randomized controlled trials using sham procedures.

Cited by 29 publications

References 46 publications

Role of the heart in blood pressure lowering during chronic baroreflex activation: insight from an in silico analysis

Role of the heart in blood pressure lowering during chronic baroreflex activation: insight from an in silico analysis

Implant-Mediated Therapy of Arterial Hypertension

Treatment of Resistant Hypertension: An Update in Device Therapy

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