Device-based Therapy for Hypertension

Abstract

Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices—renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes.

Functional Vagotopy in the Cervical Vagus Nerve of the Domestic Pig: Implications for the Study of Vagus Nerve Stimulation

“…The Food and Drug Administration (FDA) approved vagus nerve stimulation (VNS) in 1997 as an adjunctive therapy in adults with partial onset epilepsy refractory to medications (Morris et al 2013) (FDA, 1997). Subsequently, VNS was FDA approved for the treatment of depression (Wheless, Gienapp, and Ryvlin 2018), and is in clinical trials for diverse conditions such as hypertension (Ng et al 2016), heart failure (De Ferrari et al 2017), rheumatoid arthritis (Koopman et al 2016), tinnitus (Tyler et al 2017) and stroke rehabilitation (Kimberley et al 2018). Despite the growing clinical interest and some remarkable success in individual patients, VNS therapeutic effects are variable from patient to patient and are often limited by side effects including cough, throat pain, voice alteration and dyspnea (De Ferrari et al 2017).…”

When a White Horse is a Horse: Embracing the (Obvious?) Overlap Between Acupuncture and Neuromodulation

“…11 In fact, the overlap between median nerve neuromodulation and PC acupoint-targeted electroacupuncture was recently acknowledged in a review on device applications for cardiac outcomes. 12 Particularly near the wrist, the median nerve is quite shallow (*1 cm deep from the skin surface) and easily accessible by an acupuncture needle. Hence electroacupuncture can be readily applied for median nerve neuromodulation, and locally targeted indications, such as carpal tunnel syndrome, respond well to electroacupuncture, with longitudinal improvements in median nerve function and brain neuroplasticity.…”

Bioelectronics: The Promise of Leveraging the Body’s Circuitry to Treat Disease

“…In these conditions pathophysiology may be manifested in the brain, peripheral nervous system or other organs whose function is, at least in part, under neural control. Targeted peripheral neuromodulation is already approved for treating urinary incontinence [9], chronic neuropathic pain [10], and sleep apnea [11] and it is being investigated for use in a rapidly expanding list of other conditions, including rheumatoid arthritis [12], Crohn's disease [13], diabetes [14], hypertension [15] and heart failure [16].…”