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Deep Brain Stimulation for the Treatment of Resistant Hypertension

  • Device-Based Approaches for Hypertension (M Schlaich, Section Editor)
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Abstract

Hypertension is a leading risk factor for the development of several cardiovascular diseases. As the global prevalence of hypertension increases, so too has the recognition of resistant hypertension. Whilst figures vary, the proportion of hypertensive patients that are resistant to multiple drug therapies have been reported to be as high as 16.4 %. Resistant hypertension is typically associated with elevated sympathetic activity and abnormal homeostatic reflex control and is termed neurogenic hypertension because of its presumed central autonomic nervous system origin. This resistance to conventional pharmacological treatment has stimulated a plethora of medical devices to be investigated for use in hypertension, with varying degrees of success. In this review, we discuss a new therapy for drug-resistant hypertension, deep brain stimulation. The utility of deep brain stimulation in resistant hypertension was first discovered in patients with concurrent neuropathic pain, where it lowered blood pressure and improved baroreflex sensitivity. The most promising central target for stimulation is the ventrolateral periaqueductal gray, which has been well characterised in animal studies as a control centre for autonomic outflow. In this review, we will discuss the promise and potential mechanisms of deep brain stimulation in the treatment of severe, resistant hypertension.

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Conflict of Interest

Erin L. O’Callaghan, Fiona D. McBryde, Amy E. Burchell, Laura E. K. Ratcliffe, Liviu Nicolae, Derek Carr, Emma C. Hart and Angus K. Nightingale declare no conflict of interest.

Ivor Gillbe is on the board of Bioinduction Ltd., a company that has worked with Bristol University in connection with this work to validate certain aspects of its neuromodulation device under development and plans to supply devices free of charge to facilitate future research.

Nikunj K. Patel and Julian F. R. Paton have received grants from the British Heart Foundation.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. School of Physiology & Pharmacology, University of Bristol, Bristol, BS8 1TD, UK

    Erin L. O’Callaghan, Laura E. K. Ratcliffe, Derek Carr, Emma C. Hart & Julian F. R. Paton

  2. Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1142, New Zealand

    Fiona D. McBryde & Julian F. R. Paton

  3. CardioNomics, CRIC Bristol, School of Physiology & Pharmacology, University of Bristol, Bristol, BS8 1TD, UK

    Amy E. Burchell, Laura E. K. Ratcliffe, Emma C. Hart & Angus K. Nightingale

  4. Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Brunel Building, Southmead Way, Bristol, Avon, BS10 5NB, UK

    Liviu Nicolae & Nikunj K. Patel

  5. Bioinduction Ltd., 178-180 Hotwell Rd, Bristol, BS8 4RP, UK

    Ivor Gillbe

  6. Department of Cardiology, Bristol Heart Institute, Bristol, BS2 8HW, UK

    Angus K. Nightingale

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  1. Erin L. O’Callaghan
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  2. Fiona D. McBryde
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  7. Derek Carr
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  8. Emma C. Hart
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  11. Julian F. R. Paton
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Correspondence to Julian F. R. Paton.

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This article is part of the Topical Collection on Device-Based Approaches for Hypertension

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O’Callaghan, E.L., McBryde, F.D., Burchell, A.E. et al. Deep Brain Stimulation for the Treatment of Resistant Hypertension. Curr Hypertens Rep 16, 493 (2014). https://doi.org/10.1007/s11906-014-0493-1

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