Surgical treatment of hypertension with reference to baropacing

Bilgutay, Aydin M.; Lillehei, C. Walton

doi:10.1016/0002-9149(66)90404-8

Cited by 60 publications

(32 citation statements)

References 6 publications

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“…One device-mediated antihypertensive approach is activation of the baroreflex via CSS, which has been investigated since the 1960s by Bilgutay and Neistadt [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

et al. 2016

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“…One device-mediated antihypertensive approach is activation of the baroreflex via CSS, which has been investigated since the 1960s by Bilgutay and Neistadt [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

et al. 2016

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“…1,2,10 In addition, short-term (usually 5-to 7-day) experimental observations provided evidence that the efferent response to BP stimuli persists over 5 to 7 days in diverse experimental settings. 18 -24 Lohmeier et al 6 demonstrated that electric activation of the baroreflex for 7 days using the same stimulation device as that in our study produces sustained hypotension in dogs.…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation of the carotid baroreceptor (SCB) was considered several decades ago as a potential treatment for blood pressure (BP) lowering in humans. [1][2][3] The roles of carotid baroreceptors in acute regulation of BP and the acute effect of SCB are well documented. 3,4 However, whether arterial baroreceptors play a role in long-term regulation of arterial pressure is still debated, 5 and the benefit of chronic SCB as treatment of hypertension in humans is currently under investigation.…”

mentioning

confidence: 99%

Effects of Chronic Baroreceptor Stimulation on the Autonomic Cardiovascular Regulation in Patients With Drug-Resistant Arterial Hypertension

et al. 2009

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Abstract-In patients with drug-resistant hypertension, chronic electric stimulation of the carotid baroreflex is an investigational therapy for blood pressure reduction. We hypothesized that changes in cardiac autonomic regulation can be demonstrated in response to chronic baroreceptor stimulation, and we analyzed the correlation with blood pressure changes. Twenty-one patients with drug-resistant hypertension were prospectively included in a substudy of the Device Based Therapy in Hypertension Trial. Heart rate variability and heart rate turbulence were analyzed using 24-hour ECG.Recordings were obtained 1 month after device implantation with the stimulator off and after 3 months of chronic electric stimulation (stimulator on). Chronic baroreceptor stimulation decreased office blood pressure from 185Ϯ31/ 109Ϯ24 mm Hg to 154Ϯ23/95Ϯ16 mm Hg (PϽ0.0001/Pϭ0.002). Mean heart rate decreased from 81Ϯ11 to 76Ϯ10 beats per minute Ϫ1 (Pϭ0.001). Heart rate variability frequency-domain parameters assessed using fast Fourier transformation (FFT; ratio of low frequency:high frequency: 2.78 versus 2.24 for off versus on; PϽ0.001) were significantly changed during stimulation of the carotid baroreceptor, and heart rate turbulence onset was significantly decreased (turbulence onset: Ϫ0.002 versus Ϫ0.015 for off versus on; Pϭ0.004). In conclusion, chronic baroreceptor stimulation causes sustained changes in heart rate variability and heart rate turbulence that are consistent with inhibition of sympathetic activity and increase of parasympathetic activity in patients with drug-resistant systemic hypertension; these changes correlate with blood pressure reduction. Whether the autonomic modulation has favorable cardiovascular effects beyond blood pressure control should be investigated in further studies. Key Words: baroreflex Ⅲ arterial hypertension Ⅲ electric baroreflex stimulation Ⅲ heart rate variability Ⅲ heart rate turbulence Ⅲ drug-resistant arterial hypertension Ⅲ cardiac autonomic system S ystemic arterial hypertension is one of the leading cardiovascular diseases in the world and a major cardiovascular risk for coronary artery disease, cerebrovascular disease, and heart and renal failure. Despite carefully assessing causes and stratifying therapeutic approaches using all of the existing antihypertensive pharmacological agents, not all hypertensive patients sufficiently respond to pharmacological treatment. Stimulation of the carotid baroreceptor (SCB) was considered several decades ago as a potential treatment for blood pressure (BP) lowering in humans. [1][2][3] The roles of carotid baroreceptors in acute regulation of BP and the acute effect of SCB are well documented. 3,4 However, whether arterial baroreceptors play a role in long-term regulation of arterial pressure is still debated, 5 and the benefit of chronic SCB as treatment of hypertension in humans is currently under investigation. Lohmeier et al 6,7 demonstrated that electric activation of the baroreflex lasting 7 days produces sustained hypotension in dogs usin...

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“…The use of carotid sinus nerve stimulation for the treatment of hypertension and intractable angina was described in humans and animals Ͼ40 years ago. 29,[42][43][44] Although these early studies demonstrated the efficacy of this technique, it was abandoned because of limitations of implantable medical devices of that era, as well as because of improved pharmacological therapy becoming widely available. A renewed interest in carotid sinus stimulation has been generated by the development of a programmable device currently being tested for treatment of severe drug-resistant hypertension in humans.…”

Section: Discussionmentioning

confidence: 99%

Chronic Baroreceptor Activation Enhances Survival in Dogs With Pacing-Induced Heart Failure

et al. 2007

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Abstract-Much of the current pharmacological therapy for chronic heart failure targets neurohormonal activation. In spite of recent advances in drug therapy, the mortality rate for chronic heart failure remains high. Activation of the carotid baroreceptor (BR) reduces sympathetic outflow and augments vagal tone. We investigated the effect of chronic activation of the carotid BR on hemodynamic and neurohormonal parameters and on mortality in dogs with chronic heart failure. Fifteen dogs were instrumented to record hemodynamics. Electrodes were applied around the carotid sinuses to allow for activation of the BR. After 2 weeks of pacing (250 bpm), electrical carotid BR activation was initiated in 7 dogs and continued for the remainder of the study.

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Surgical treatment of hypertension with reference to baropacing

Cited by 60 publications

References 6 publications

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

Effects of Chronic Baroreceptor Stimulation on the Autonomic Cardiovascular Regulation in Patients With Drug-Resistant Arterial Hypertension

Chronic Baroreceptor Activation Enhances Survival in Dogs With Pacing-Induced Heart Failure

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