Carotid Baroreceptor Stimulation, Sympathetic Activity, Baroreflex Function, and Blood Pressure in Hypertensive Patients
Karsten Heusser,Jens Tank,Stefan Engeli,André Diedrich,Jan Menne,Siegfried Eckert,Tim J Peters,Fred C.G.J. Sweep,Hermann Haller,Andreas M. Pichlmaier,Friedrich C. Luft,Jens Jordan +11 more
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Electric field stimulation of carotid sinus baroreflex afferents acutely decreased arterial blood pressure in hypertensive patients, without negative effects on physiological barore Flex regulation.Abstract:
In animals, electric field stimulation of carotid baroreceptors elicits a depressor response through sympathetic inhibition. We tested the hypothesis that the stimulation acutely reduces sympathetic vasomotor tone and blood pressure in patients with drug treatment-resistant arterial hypertension. Furthermore, we tested whether the stimulation impairs the physiological baroreflex regulation. We studied 7 men and 5 women (ages 43 to 69 years) with treatment-resistant arterial hypertension. A bilateral electric baroreflex stimulator at the level of the carotid sinus (Rheos) was implanted > or =1 month before the study. We measured intra-arterial blood pressure, heart rate, muscle sympathetic nerve activity (microneurography), cardiac baroreflex sensitivity (cross-spectral analysis and sequence method), sympathetic baroreflex sensitivity (threshold technique), plasma renin, and norepinephrine concentrations. Measurements were performed under resting conditions, with and without electric baroreflex stimulation, for > or =6 minutes during the same experiment. Intra-arterial blood pressure was 193+/-9/94+/-5 mm Hg on medications. Acute electric baroreflex stimulation decreased systolic blood pressure by 32+/-10 mm Hg (range: +7 to -108 mm Hg; P=0.01). The depressor response was correlated with a muscle sympathetic nerve activity reduction (r(2)=0.42; P<0.05). In responders, muscle sympathetic nerve activity decreased sharply when electric stimulation started. Then, muscle sympathetic nerve activity increased but remained below the baseline level throughout the stimulation period. Heart rate decreased 4.5+/-1.5 bpm with stimulation (P<0.05). Plasma renin concentration decreased 20+/-8% (P<0.05). Electric field stimulation of carotid sinus baroreflex afferents acutely decreased arterial blood pressure in hypertensive patients, without negative effects on physiological baroreflex regulation. The depressor response was mediated through sympathetic inhibition.read more
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A Call to Action and a Lifecourse Strategy to Address the Global Burden of Raised Blood Pressure on Current and Future Generations: The Lancet Commission on Hypertension
Michael H. Olsen,Michael H. Olsen,Sonia Y. Angell,Samira Asma,Pierre Boutouyrie,Dylan Burger,Julio A. Chirinos,Albertino Damasceno,Christian Delles,Anne Paule Gimenez-Roqueplo,Anne Paule Gimenez-Roqueplo,Dagmara Hering,Patricio Lopez-Jaramillo,Fernando Martinez,Vlado Perkovic,Ernst Rietzschel,Giuseppe Schillaci,Aletta E. Schutte,Angelo Scuteri,James E. Sharman,Kristian Wachtell,Ji-Guang Wang +21 more
TL;DR: The Commission has identified ten essential and achievable goals and ten accompanying, mutually additive, and synergistic key actions that—if implemented effectively and broadly—will make substantial contributions to the management of blood pressure globally.
Journal ArticleDOI
Baroreflex Activation Therapy Lowers Blood Pressure in Patients With Resistant Hypertension Results From the Double-Blind, Randomized, Placebo-Controlled Rheos Pivotal Trial
John D. Bisognano,George L. Bakris,Mitra K. Nadim,Luis A. Sanchez,Abraham A. Kroon,Jill E. Schafer,Peter W. de Leeuw,Domenic A. Sica +7 more
TL;DR: The weight of the overall evidence suggests that over the long-term, BAT can safely reduce SBP in patients with resistant hypertension.
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Role of the Autonomic Nervous System in Atrial Fibrillation: Pathophysiology and Therapy
TL;DR: In this article, the authors focus on the relationship between the autonomic nervous system and the pathophysiology of atrial fibrillation and the potential benefit and limitations of neuromodulation in the management of this arrhythmia.
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Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure A Scientific Statement From the American Heart Association
Robert D. Brook,Lawrence J. Appel,Melvyn Rubenfire,Gbenga Ogedegbe,John D. Bisognano,William J. Elliott,Flávio Danni Fuchs,Joel W. Hughes,Daniel T. Lackland,Beth A. Staffileno,Raymond R. Townsend,Sanjay Rajagopalan +11 more
TL;DR: It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate.
Journal ArticleDOI
The human sympathetic nervous system: its relevance in hypertension and heart failure
TL;DR: The blood pressure lowering achieved with carotid baroreceptor stimulation and with the renal denervation device affirms the importance of the sympathetic nervous system in hypertension pathogenesis, and perhaps suggests a wider role for anti-adrenergic antihypertensives, such as the imidazoline drug class which act within the CNS to inhibit central sympathetic outflow.
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