Current Hypertension Reports

, Volume 8, Issue 5, pp 420–424

Electrical stimulation of the carotid sinus for the treatment of resistant hypertension

  • J. D. Filippone
  • James A. Sloand
  • Karl A. Illig
  • John D. Bisognano
Article

Abstract

Hypertension is a major cause of morbidity and mortality worldwide. Despite a myriad of oral agents, many patients fail to reach their target blood pressure. Electrical stimulation of the carotid sinus, an old therapeutic concept, lowers blood pressure by initiating the barore flex and reducing sympathetic tone. Recent evidence suggests that the baroreflex is more important in the setting of chronic hypertension than originally believed. The carotid stimulator may be a safe and effective therapeutic option for patients with resistant hypertension.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Heart Association, http://www.americanheart. org/presenter.jhtml?identifier=4621 Hypertension Statistics. Accessed July 21, 2006.Google Scholar
  2. 2.
    Spranger C, Ries AJ, Berge CA, et al.: Identifying gaps between guidelines and clinical practice in the evaluation and treatment of patients with hypertension. Am J Med 2004, 117:14–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Berlowitz D, Ash AS, Hickey EC, et al.: Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998, 339:1957–1963.PubMedCrossRefGoogle Scholar
  4. 4.
    McFarlane SI, Castro J, Kaur J, et al.: Control of blood pressure and other cardiovascular risk factors at different practice settings: outcomes of care provided to diabetic women compared to men. J Clin Hypertens 2005, 7:73–80.Google Scholar
  5. 5.
    Hajjar I, Kotchen TA: Trends in prevalence, awareness, treatment and control of hypertension in the United States, 1988–2000. JAMA 2003, 290:199–206.PubMedCrossRefGoogle Scholar
  6. 6.
    Cushman WC, Ford CE, Cutler JA, et al.: Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2003:4:393–404.Google Scholar
  7. 7.
    Staessen JA, Wang JG, Thijs L: Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 2001:358:1305–1315.PubMedCrossRefGoogle Scholar
  8. 8.
    Staessen JA, Wang JG, Thijs L: Cardiovascular protection and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens 2003, 21:1055–1076.PubMedCrossRefGoogle Scholar
  9. 9.
    Lampen H, Kezdi P, Koppermann E, et al.: Experimenteller entzugelungshochdruck bei arterieller hypertonie. Z Kreislaufforschung 1949, 38:577–592.Google Scholar
  10. 10.
    Carlsten A, Folkow B, Grimby G, et al.: Cardiovascular effects of direct simulation of the carotid sinus nerve in man. Acta Physiol Scanda 1958, 44:138–145.Google Scholar
  11. 11.
    Bisognano J, Sloand J, Papademetriou V, et al.:Baroreflex hypertension therapy with a chronically implanted system: early results from the Rheos feasibility trial in patients with resistant hypertension. J Clin Hypertension 2006, 8(Supp A):850.Google Scholar
  12. 12.
    Esler M: The sympathetic system and hypertension. Am J Hypertens 2000, 13:99S-105S.PubMedCrossRefGoogle Scholar
  13. 13.
    Esler M, Rumantir M, Wiesner G, et al.: Sympathetic nervous system and insulin resistance: from obesity to diabetes. Am J Hypertension 2001, 14:304S-309S.CrossRefGoogle Scholar
  14. 14.
    Grassi G, Esler M: The sympathetic nervous system in renovascular hypertension: lead actor or ‘bit" player? J Hypertens 2002, 20:1071–1073.PubMedCrossRefGoogle Scholar
  15. 15.
    Anderson EA, Sinkey CA, Lawton WJ, Mark AL: Elevated sympathetic nerve activity in borderline hypertensive humans-evidence from direct intraneural recordings. Hypertension 1989, 14:177–183.PubMedGoogle Scholar
  16. 16.
    Lohmeier TE: The sympathetic nervous system and longterm blood pressure regulation. Am J Hypertens 2001, 14:147S-154S.PubMedCrossRefGoogle Scholar
  17. 17.
    Ferrier C, Cox H, Esler M: Elevated total body noradrenaline spillover in normotensive members of hypertensive families. Clin Sci 1993, 84:225–230.PubMedGoogle Scholar
  18. 18.
    Braunwald E: Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders; 2001:2173.Google Scholar
  19. 19.
    Chapleau M: Arterial Baroreflexes. In Hypertension Primer Second Edition, The Essentials of High Blood Pressure. Edited by Council on High Blood Pressure Research, American Heart Association. Hagerstown, MD: Lippincott Williams & Wilkins; 1999:83.Google Scholar
  20. 20.
    Timmers HJML, Wieling W, Karemaker JM, Lenders JWM: Baroreflex failure: a neglected type of secondary hypertension, Neth J Med 2004, 62:151–155.PubMedGoogle Scholar
  21. 21.
    Rooke T, Sparks H: Control mechanisms in circulatory function. In Medical Physiology, edn 2. Edited by Rhoades RA, Tanner GA. Baltimore, MD: Lippincot Williams & Wilkins; 290–303.Google Scholar
  22. 22.
    Neistadt A, Schwartz S: Effects of electrical stimulation of the carotid sinus nerve in reversal of experimentally induced hypertension. Surgery 1967, 61:923–931.PubMedGoogle Scholar
  23. 23.
    Rodney LJ: Cardiovascular receptor reflexes and central control. In An Introduction to Cardiovascular Physiology, edn 4. Edited by Levick JR. London: Hodder Arnold; 2003:279–296.Google Scholar
  24. 24.
    Mohrman DE, Heller LJ: Cardiovascular Physiology, edn 4. New York: McGraw-Hill; 2003:151–158.Google Scholar
  25. 25.
    Lohmeier TE, Hildebrandt DA, Warren S, et al.: Recent insights into the interactions between the baroreflex and the kidneys in hypertension. Am J Physiol Regul Integr Comp Physiol 2005, 288:R828-R836.PubMedGoogle Scholar
  26. 26.
    McCubbin JW, Green JH, Page IH: Baroreceptor function in chronic renal hypertension. Circ Res 1956, 4:205–210.PubMedGoogle Scholar
  27. 27.
    Malpas SC: What sets the long-term level of sympathetic nerve activity: Is there a role for aterial baroreceptors? Am J Physiol Regul Integr Comp Physiol 2004, 286:R1-R12. A nice review of the evidence that the baroreflex is important in long-term regulation of the SNS and blood-pressure control.PubMedGoogle Scholar
  28. 28.
    Bristow JD, Honour AJ, Pickering GW, et al.: Diminished baroreflex sensitivity in high blood pressure. Circulation 1969, 39:48–54.PubMedGoogle Scholar
  29. 29.
    Lohmeier TE: The sympathetic nervous system and longterm blood pressure regulation. Am J Hypertens 2001, 14:147S-154S.PubMedCrossRefGoogle Scholar
  30. 30.
    Warner HR: The frequency-dependent nature of blood pressure regulation by the carotid sinus studied with an electrical analog. Circ Res 1958, 6:35–40.PubMedGoogle Scholar
  31. 31.
    Bilgutay A, Lillehei W: Treatment of hypertension with an implantable electronic device. JAMA 1965, 191:113–117.Google Scholar
  32. 32.
    Bilgutay A, Lillehei W: Surgical treatment of hypertension with reference to baropacing. Am J Cardiol 1966, 17:663–667.PubMedCrossRefGoogle Scholar
  33. 33.
    Schwartz S, Griffith L, Neistadt A, Hagfors N: Chronic carotid sinus nerve stimulation in the treatment of essential hypertension. Am J Surg 1967, 114:5–15.PubMedCrossRefGoogle Scholar
  34. 34.
    Neufeld H, Goor D, Nathan D, et al.: Stimulation of the carotid baroreceptors using a radiofrequency method. Isralei J Med Sci 1965, 1:630–632.Google Scholar
  35. 35.
    Braunwald E, Epstein S, Glick G, et al.: Relief of angina pectoris by electrical stimulation of the carotid-sinus nerves. N Engl J Med 1967, 277:1278–1283.PubMedCrossRefGoogle Scholar
  36. 36.
    Tuckman J, Reich T, Lyon A, et al.: Electrical stimulation of the sinus nerves in hypertensive patients-clinical evaluation and physiological studies. Hypertension 1967, 194S:23–38.Google Scholar
  37. 37.
    Peters T, Koralewski H, Zerbst E: Search for optimal frequencies and amplitudes of therapeutic electrical carotid sinus nerve stimulation by application of the evolutionary strategy. Artif Organs 1989, 13:133–143.PubMedCrossRefGoogle Scholar
  38. 38.
    Peters T, Koralewski H, Zerbst E: The principle of electrical carotid sinus nerve stimulation: a nerve pacemaker system for angina pectoris and hypetension therapy. Ann Biomed Eng 1980, 8:445–458.PubMedCrossRefGoogle Scholar
  39. 39.
    Wallin BG, Sundlof G, Delius W: The effect of carotid sinus nerve stimulation on muscle and skin nerve sympathetic activity in man. Pflugers Arch 1975, 358:101–110.PubMedCrossRefGoogle Scholar
  40. 40.
    Ferrier C, Cox H, Esler M: Elevated total body noradrenaline spillover in normotensive members of hypertensive families. Clin Sci 1993, 84:225–230.PubMedGoogle Scholar
  41. 41.
    Mancia G, Grassi G, Giannattasio C, Servalle G: Sympathetic activation in the pathogenesis of hypertension and progressive organ damage. Hypertension 1999, 34:724–728.PubMedGoogle Scholar
  42. 42.
    Lohmeier TE, Lohmeier JR, Warren S, et al.: Sustained activation of the central baroreceptor pathway in angiotensin hypertension. Hypertension 2002, 39:550–556.PubMedCrossRefGoogle Scholar
  43. 43.
    Lohmeier TE, Lohmeier JR, Haque A, Hilderbrandt DA: Baroreflexes prevent neurally induced sodium retention in angiotensin hypertension. Am J Phsiol Regul Integr Comp Physiol 2000, 279:R1437-R1448.Google Scholar
  44. 44.
    Lohmeier TE, Hildebrandt DA, Warren S, et al.: Recent insights into the interactions between the baroreflex and the kidneys in hypertension. Am J Physiol Regul Integr Comp Physiol 2005, 288:R828-R836.PubMedGoogle Scholar
  45. 45.
    Lohmeier T, Irwin E, Rossing M, et al.: Prolonged activation of the baroreflex produces sustained hypotension. Hypertension 2004, 43:306–311. Lohmeier has done much of the work elucidating the role of the baroreflex in blood pressure regulation, and this paper demonstrates the importance of renal sympathoinhibition in the antihypertensive effect of the carotid stimulator.PubMedCrossRefGoogle Scholar
  46. 46.
    Lohmeier TE, Dwyer TM, Jackson MS, et al.: Prolonged activation of the baroreflex abolishes obesity-induced hypertension. Hypertension 2005, 46:816.CrossRefGoogle Scholar
  47. 47.
    Lohmeier TE, Dwyer TM, Hildebrandt DA, et al.: Influence of prolonged baroreflex activation on arterial pressure in angiotensin hypertension. Hypertension 2005, 46:1194–1200.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • J. D. Filippone
  • James A. Sloand
  • Karl A. Illig
  • John D. Bisognano
    • 1
  1. 1.Program in Heart Failure and TransplantationUniversity of Rochester, Cardiology DivisionRochesterUSA

Personalised recommendations