Effect of baroreflex activation therapy on renal sodium excretion in patients with resistant hypertension

  • Mark Lipphardt
  • Michael J. Koziolek
  • Luca-Yves Lehnig
  • Ann-Kathrin Schäfer
  • Gerhard A. Müller
  • Stephan Lüders
  • Manuel WallbachEmail author
Original Paper



Activation of the sympathetic nervous system increases sodium retention in resistant hypertension. Baroreflex activation therapy (BAT) is an interventional method to reduce sympathetic overactivity in patients with resistant hypertension. This study aimed to assess the effect of BAT on urinary sodium excretion.


From 2012 to 2015, consecutive patients with resistant hypertension and blood pressure (BP) above target despite polypharmacy strategies were consecutively included in this observational study. BAT was provided with the individual adaption of programmed parameters over the first months. 24-h urinary sodium excretion (UNa) was estimated at baseline and after 6 months using the Kawasaki formula in patients undergoing BAT. Additionally, the fractional sodium excretion, plasma renin activity, and aldosterone levels were assessed.


Forty-two patients completed the 6-month follow-up period. Office systolic and ambulatory 24-h systolic BP at baseline were 169 ± 27 mmHg and 148 ± 16 mmHg despite a median intake of 7(3–9) antihypertensive drugs. After 6 months of BAT, systolic office BP decreased to 150 ± 29 mmHg (p < 0.01), 24-h systolic BP to 142 ± 22 mmHg (p = 0.04) and 24-h UNa increased by 37% compared to baseline (128 ± 66 vs. 155 ± 83 mmol/day, p < 0.01). These findings were accompanied by a significant increase in fractional sodium excretion (0.74% [0.43–1.47] to 0.92% [0.61–1.92]; p = 0.02). However, in contrast to the significant BP reduction, eGFR, plasma sodium, renin activity and aldosterone levels did not change during BAT. The increase in sodium excretion was correlated with the change in eGFR (r = 0.371; p = 0.015).


The present study revealed a significant increase of estimated 24-h UNa which may contribute to the long-term BP-lowering effects of this interventional method.


Resistant hypertension Urinary sodium excretion Kawasaki formula Sympathetic nervous system Baroreflex activation therapy 



Baroreflex activation therapy


Body mass index


Blood pressure


Estimated glomerular filtration rate


Arterial hypertension


Inter-quartile range


Mineralocorticoid receptor antagonists


24-h urinary sodium excretion (UNa)


Renin–angiotensin aldosterone system


Standard deviation



The authors thank Mrs. C. Biegler for assistance, Dr. D. Zenker, Dept. of thoracic-cardiac-vascular surgery, for BAT implantation, and the employees of CVRx for technical support.



Compliance with ethical standards

Conflict of interest

MW and MK declare lecture fees and/or funding of CVRx. Research program, Faculty of Medicine, Georg-August-University Göttingen, to MW and a research grant from CVRx to MK and MW. ML, LYL, AKS, GM and SL declare that they have no conflict of interest.

Supplementary material

392_2019_1464_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nephrology and RheumatologyUniversity Medical Center GöttingenGöttingenGermany
  2. 2.St. Josefs HospitalCloppenburgGermany

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