Baroreflex activation therapy for patients with drug-resistant hypertension

Abstract

Uncontrolled or resistant hypertension is still a major problem facing many physicians daily in the clinic. Several new therapies are being developed to help those patients whose blood pressure does not respond sufficiently to regular antihypertensive medication. One of these promising therapies is electrical activation of the carotid sinus baroreflex. In this overview, the authors predominantly summarize the background, efficacy and safety of this promising treatment with its latest achievements in patients with resistant hypertension. The authors also discuss certain issues that need further clarification before this therapy can be added to the common treatment guidelines of hypertension.

Keywords::

• baroreceptor
• baroreflex activation therapy
• resistant hypertension

Financial & competing interests disclosure

The authors were supported by a research grant from CVRx, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Electrical carotid baroreflex activation is a device-based therapy for the treatment of resistant hypertension.

• It consists of a battery, which is implanted subcutaneously in the infraclavicular area, and an electrode attached around the carotid sinus. The electrode delivers electrical discharge to the carotid sinus, which triggers baroreceptor fibers to simulate the baroreflex mechanism. This results in an acute drop in blood pressure, which has been shown to be sustained and safe over years of therapy.

• Not all patients with resistant hypertension seem to be suitable candidates for this therapy. Further studies are required to clarify the exact working mechanisms for selecting the right candidate.

• New developments in the field of this device are awaited to reduce the invasiveness of the implantation procedure and extend its application to other diseases with increased sympathetic activity (hypertension, heart failure, end-stage kidney disease).

Notes