Baroreflex Activation Therapy Lowers Arterial Pressure Without Apparent Stimulation of the Carotid Bodies

Alnima, Teba; Goedhart, Emilie J.B.M.; Seelen, Randy; Grinten, C.P.M. van der; Leeuw, Peter W. de

doi:10.1161/hypertensionaha.114.201404354

Cited by 2 publications

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“…In an experimental rat model with combined electric stimulation of the carotid sinus and CSN, blunting of carotid baroreflex‐mediated hypotension was demonstrated, due to concomitant carotid chemoreceptor activation (Katayama et al, ). Conversely, Alnima et al () showed that baroreflex activation therapy in patients with resistant hypertension does not stimulate the chemoreceptor components of the CSN to any significant extent.…”

Section: Clinical Implications—the Csn As Therapeutic Targetmentioning

confidence: 98%

The Carotid Sinus Nerve—Structure, Function, and Clinical Implications

Porzionato

Macchi

Stecco

et al. 2018

The Anatomical Record

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Interest has been renewed in the anatomy and physiology of the carotid sinus nerve (CSN) and its targets (carotid sinus and carotid body, CB), due to recent proposals of surgical procedures for a series of common pathologies, such as carotid sinus syndrome, hypertension, heart failure, and insulin resistance. The CSN originates from the glossopharyngeal nerve soon after its appearance from the jugular foramen. It shows frequent communications with the sympathetic trunk (usually at the level of the superior cervical ganglion) and the vagal nerve (main trunk, pharyngeal branches, or superior laryngeal nerve). It courses on the anterior aspect of the internal carotid artery to reach the carotid sinus, CB, and/or intercarotid plexus. In the carotid sinus, type I (dynamic) carotid baroreceptors have larger myelinated A-fibers; type II (tonic) baroreceptors show smaller A- and unmyelinated C-fibers. In the CB, afferent fibers are mainly stimulated by acetylcholine and ATP, released by type I cells. The neurons are located in the petrosal ganglion, and centripetal fibers project on to the solitary tract nucleus: chemosensory inputs to the commissural subnucleus, and baroreceptor inputs to the commissural, medial, dorsomedial, and dorsolateral subnuclei. The baroreceptor component of the CSN elicits sympatho-inhibition and the chemoreceptor component stimulates sympatho-activation. Thus, in refractory hypertension and heart failure (characterized by increased sympathetic activity), baroreceptor electrical stimulation, and CB removal have been proposed. Instead, denervation of the carotid sinus has been proposed for the "carotid sinus syndrome." Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Clinical Implications—the Csn As Therapeutic Targetmentioning

confidence: 98%

The Carotid Sinus Nerve—Structure, Function, and Clinical Implications

Porzionato

Macchi

Stecco

et al. 2018

The Anatomical Record

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“…Consideration of interventions such as renal angioplasty, 20 renal artery nerve ablation, 21 carotid sinus stimulation 22 and creation of a femoral arterio-venous anastomosis 23 are reserved for rare cases usually under research conditions as their routine safety and effectiveness have not yet been proven beyond doubt.…”

Section: Resistance To Three-drug Combinationsmentioning

confidence: 99%

Managing hypertension and meeting targets

Lewis¹

2015

Prescriber

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T he ultimate goal of identifying and treating patients with hypertension is to reduce the potential morbidity and premature mortality associated with the condition. Despite constantly updated evidence-based guidelines and a wide choice of potent, effective and usually well-tolerated antihypertensive drugs, only 37 per cent of patients have their blood pressure (BP) adequately controlled.1 While perfect control does not prevent cardiovascular disease (CVD), compared to normotensive subjects there is a 37 per cent greater lifetime risk of developing CVD in those with a BP >140/90mmHg, which will develop on average five years earlier. 2The current BP targets are not under dispute, but to achieve greater accuracy you need to: have a clear understanding of the long-term life and death implications of failure; concentrate on achieving the goal; achieve a balance of effort (neither too quick nor too slow) and know when to call it a day; focus on the details; and remain personally responsible for the equipment and methods you use. There is no big secret to success; it results from a combination of good theoretical and practical preparation, experience, good equipment and methodology, excellent teamwork, continually learning from others and not giving in until the best possible outcome has been achieved. Accurate BP assessment is the basis of diagnosis and subsequent monitoringThe NICE guideline for hypertension (CG127) defines it as a clinic BP reading of ≥140/90mmHg combined with an ambulatory daytime or home BP average of ≥135/85mmHg (for those patients aged 80 years and over, the threshold clinic BP for diagnosis is ≥160/100mmHg with a home or ambulatory daytime mean of ≥150/95mmHg Despite constantly updated guidelines and a wide choice of drugs for hypertension only 37 per cent of patients have their blood pressure (BP) adequately controlled. This article give practical tips on how best to achieve the targets for BP control using current guidelines. SPL

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Baroreflex Activation Therapy Lowers Arterial Pressure Without Apparent Stimulation of the Carotid Bodies

Cited by 2 publications

References 0 publications

The Carotid Sinus Nerve—Structure, Function, and Clinical Implications

The Carotid Sinus Nerve—Structure, Function, and Clinical Implications

Managing hypertension and meeting targets

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