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Barorezeptorakivierungstherapie bei therapierefraktärer Hypertonie: Indikation und Patientenselektion

Empfehlungen der BAT-Konsensusgruppe 2017

Baroreceptor activation therapy for therapy-resistant hypertension: indications and patient selection

Recommendations of the BAT consensus group 2017

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Zusammenfassung

Zur Behandlung der therapierefraktären Hypertonie (trHTN) steht seit einigen Jahren die Möglichkeit der Barorezeptoraktivierungstherapie (BAT) zur Verfügung. Das Verfahren wird derzeit in Deutschland an einer begrenzten Anzahl von Standorten durchgeführt, auch mit dem Ziel, eine hohe Expertise durch ausreichende Erfahrung anzubieten. Durch eine wachsende Zahl von Patienten, die mit einer BAT behandelt werden, treten jedoch im ärztlichen Alltag immer wieder Probleme im Umgang mit diesen Patienten auf. Um diese Probleme zu adressieren, wurde im November 2016 eine Konsensuskonferenz mit Experten auf dem Gebiet der trHTN durchgeführt, die die aktuellen Evidenzen und Erfahrungen, aber auch Problembereiche im Umgang mit BAT-Patienten zusammenfasst.

Abstract

Baroreceptor activation therapy (BAT) has been available for several years for treatment of therapy-refractory hypertension (trHTN). This procedure is currently being carried out in a limited number of centers in Germany, also with the aim of offering a high level of expertise through sufficient experience; however, a growing number of patients who are treated with BAT experience problems that treating physicians are confronted with in routine medical practice. In order to address these problems, a consensus conference was held with experts in the field of trHTN in November 2016, which summarizes the current evidence and experience as well as the problem areas in handling BAT patients.

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Literatur

  1. Abraham WT, Zile MR, Weaver FA et al (2015) Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction. JACC Heart Fail 3:487–496

    Article  PubMed  Google Scholar 

  2. Alnima T, de Leeuw PW, Tan FE, Kroon AA, Rheos Pivotal Trial Investigators (2013) Renal responses to long-term carotid baroreflex activation therapy in patients with drug-resistant hypertension. Hypertension 61:1334–1339

    Article  CAS  PubMed  Google Scholar 

  3. Alnima T, Goedhart EJ, Seelen R et al (2015) Baroreflex activation therapy lowers arterial pressure without apparent stimulation of the carotid bodies. Hypertension 65:1217–1222

    Article  CAS  PubMed  Google Scholar 

  4. Bakris GL, Nadim MK, Haller H et al (2012) Baroreflex activation therapy provides durable benefit in patients with resistant hypertension: results of long-term follow-up in the Rheos Pivotal Trial. J Am Soc Hypertens 6:152–158

    Article  PubMed  Google Scholar 

  5. Beige J, Jentzsch T, Wendt R et al (2017) Blood pressure after blinded, randomized withdrawal, and resumption of baroreceptor-activating therapy. J Hypertens 35(7):1496–1501. doi:https://doi.org/10.1097/hjh.0000000000001339

    Article  CAS  PubMed  Google Scholar 

  6. Beige J, Koziolek MJ, Hennig G et al (2015) Baroreflex activation therapy in patients with end-stage renal failure: proof of concept. J Hypertens 33:2344–2349

    Article  CAS  PubMed  Google Scholar 

  7. Bhatt DL, Kandzari DE, O’Neill WW et al (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370:1393–1401

    Article  CAS  PubMed  Google Scholar 

  8. Bisognano JD, Bakris G, Nadim MK, Sanchez L, Kroon AA, Schafer J, de Leeuw PW, Sica DA (2011) Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol 58:765–773

    Article  PubMed  Google Scholar 

  9. Borgel J, Springer S, Ghafoor J et al (2010) Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence. Clin Res Cardiol 99:499–506

    Article  PubMed  Google Scholar 

  10. Brunner-La Rocca HP, Esler MD, Jennings GL et al (2001) Effect of cardiac sympathetic nervous activity on mode of death in congestive heart failure. Eur Heart J 22:1136–1143

    Article  CAS  PubMed  Google Scholar 

  11. de Leeuw PW (2015) Unilateral baroreceptor activation therapy: the beauty of asymmetry. Expert Rev Cardiovasc Ther 13:739–741

    Article  PubMed  Google Scholar 

  12. de Leeuw PW, Bisognano JD, Bakris GL et al (2017) Sustained reduction of blood pressure with baroreceptor activation therapy: results of the 6‑year open follow-up. Hypertension 69:836–843

    Article  PubMed  Google Scholar 

  13. Grassi G, Quarti-Trevano F, Seravalle G et al (2011) Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension 57:846–851

    Article  CAS  PubMed  Google Scholar 

  14. Halbach M, Fritz T, Madershahian N et al (2016) Baroreflex activation therapy in heart failure with reduced ejection fraction: available data and future perspective. Curr Heart Fail Rep 13:71–76

    Article  CAS  PubMed  Google Scholar 

  15. Halbach M, Hickethier T, Madershahian N et al (2015) Acute on/off effects and chronic blood pressure reduction after long-term baroreflex activation therapy in resistant hypertension. J Hypertens 33:1697–1703

    Article  CAS  PubMed  Google Scholar 

  16. Heusser K, Tank J, Brinkmann J et al (2016) Acute response to unilateral unipolar electrical carotid sinus stimulation in patients with resistant arterial hypertension. Hypertension 67:585–591

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Heusser K, Tank J, Engeli S et al (2010) Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension 55:619–626

    Article  CAS  PubMed  Google Scholar 

  18. Hildebrandt DA, Irwin ED, Lohmeier TE (2016) Prolonged baroreflex activation abolishes salt-induced hypertension after reductions in kidney mass. Hypertension 68(6):1400–1406

    Article  CAS  PubMed  Google Scholar 

  19. Hoppe UC, Brandt MC, Wachter R et al (2012) Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial. J Am Soc Hypertens 6:270–276

    Article  PubMed  Google Scholar 

  20. Illig KA, Levy M, Sanchez L et al (2006) An implantable carotid sinus stimulator for drug-resistant hypertension: surgical technique and short-term outcome from the multicenter phase II Rheos feasibility trial. J Vasc Surg 44:1213–1218

    Article  PubMed  Google Scholar 

  21. Jordan J, Tank J, Hohenbleicher H et al (2002) Heterogeneity of autonomic regulation in hypertension and neurovascular contact. J Hypertens 20:701–706

    Article  CAS  PubMed  Google Scholar 

  22. Jung O, Gechter JL, Wunder C et al (2013) Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens 31:766–774

    Article  CAS  PubMed  Google Scholar 

  23. Katayama PL, Castania JA, Dias DP et al (2015) Role of chemoreceptor activation in hemodynamic responses to electrical stimulation of the carotid sinus in conscious rats. Hypertension 66:598–603

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lohmeier TE, Dwyer TM, Hildebrandt DA et al (2005) Influence of prolonged baroreflex activation on arterial pressure in angiotensin hypertension. Hypertension 46:1194–1200

    Article  CAS  PubMed  Google Scholar 

  25. Lohmeier TE, Dwyer TM, Irwin ED et al (2007) Prolonged activation of the baroreflex abolishes obesity-induced hypertension. Hypertension 49:1307–1314

    Article  CAS  PubMed  Google Scholar 

  26. Lohmeier TE, Irwin ED, Rossing MA et al (2004) Prolonged activation of the baroreflex produces sustained hypotension. Hypertension 43:306–311

    Article  CAS  PubMed  Google Scholar 

  27. Lohmeier TE, Liu B, Hildebrandt DA et al (2015) Global- and renal-specific sympathoinhibition in aldosterone hypertension. Hypertension 65:1223–1230

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. May M, Ahrens J, Menne J et al (2014) Limited acute influences of electrical baroreceptor activation on insulin sensitivity and glucose delivery: a randomized, double-blind, crossover clinical study. Diabetes 63:2833–2837

    Article  CAS  PubMed  Google Scholar 

  29. Scheffers IJ, Kroon AA, Schmidli J et al (2010) Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study. J Am Coll Cardiol 56:1254–1258

    Article  PubMed  Google Scholar 

  30. Schroer C, Wallbach M, Lehnig LY, Koziolek M, Wachter R (2015) 81th annual meeting of the German Cardiac Society – cardiac and circulation research, April 8.–11. 2015, Mannheim. Clin Res Cardiol 104(Suppl 1):1

    Google Scholar 

  31. Sica DA, Lohmeier TE (2006) Baroreflex activation for the treatment of hypertension: principles and practice. Expert Rev Med Devices 3:595–601

    Article  PubMed  Google Scholar 

  32. Tordoir JH, Scheffers I, Schmidli J et al (2007) An implantable carotid sinus baroreflex activating system: surgical technique and short-term outcome from a multi-center feasibility trial for the treatment of resistant hypertension. Eur J Vasc Endovasc Surg 33:414–421

    Article  CAS  PubMed  Google Scholar 

  33. Wachter R, Halbach M, Bakris GL et al (2016) An exploratory propensity score matched comparison of second-generation and first-generation baroreflex activation therapy systems. J Am Soc Hypertens 11(2):81–91

    Article  PubMed  Google Scholar 

  34. Wallbach M, Halbach M, Reuter H et al (2016) Baroreflex activation therapy in patients with prior renal denervation. J Hypertens 34(8):1630–1638. doi:https://doi.org/10.1097/hjh.0000000000000949

    Article  CAS  PubMed  Google Scholar 

  35. Wallbach M, Lehnig LY, Helms HJ et al (2015) Long-term effects of baroreflex activation therapy on glucose metabolism. Acta Diabetol 52:829–835

    Article  CAS  PubMed  Google Scholar 

  36. Wallbach M, Lehnig LY, Schroer C et al (2014) Impact of baroreflex activation therapy on renal function – a pilot study. Am J Nephrol 40:371–380

    Article  PubMed  Google Scholar 

  37. Wallbach M, Lehnig LY, Schroer C et al (2015) Effects of baroreflex activation therapy on arterial stiffness and central hemodynamics in patients with resistant hypertension. J Hypertens 33:181–186

    Article  CAS  PubMed  Google Scholar 

  38. Wallbach M, Lehnig LY, Schroer C et al (2016) Effects of baroreflex activation therapy on ambulatory blood pressure in patients with resistant hypertension. Hypertension 67:701–709

    Article  CAS  PubMed  Google Scholar 

  39. Wustmann K, Kucera JP, Scheffers I et al (2009) Effects of chronic baroreceptor stimulation on the autonomic cardiovascular regulation in patients with drug-resistant arterial hypertension. Hypertension 54:530–536

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    M. Koziolek & M. Wallbach

  2. Abteilung Nephrologie und KfH-Nierenzentrum, Klinikum St. Georg Leipzig, Leipzig, Deutschland

    J. Beige

  3. Martin-Luther-Universität Halle/Wittenberg, Halle, Deutschland

    J. Beige

  4. Klinik für Thorax‑, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    D. Zenker

  5. Klinik für Gefäßchirurgie, Klinikum St. Georg, Leipzig, Deutschland

    G. Henning

  6. Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln, Deutschland

    M. Halbach & H. Reuter

  7. Klinik für Herz- und Thoraxchirurgie, Herzzentrum der Universität zu Köln, Köln, Deutschland

    N. Mader

  8. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Deutschland

    F. Mahfoud

  9. MVZ DaVita Rhein-Ruhr, Düsseldorf, Deutschland

    G. Schlieper

  10. Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum Stuttgart, Stuttgart, Deutschland

    V. Schwenger

  11. Medizinische Klinik I, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    M. Hausberg

  12. Innere Medizin I, St. Barbara-Klinik Hamm-Heessen, Hamm-Heessen, Deutschland

    J. Börgel & M. Lodde

  13. Medizinische Klinik für Nephrologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    M. van der Giet

  14. 3. Medizinische Abteilung, Asklepios Klinik Altona, Hamburg, Deutschland

    J. Müller-Ehmsen

  15. Medizinische Klinik und Poliklinik III, Universitätsklinikum Dresden, Dresden, Deutschland

    J. Passauer & S. Parmentier

  16. Klinik für Nephrologie, St. Josefs-Hospital Cloppenburg, Cloppenburg, Deutschland

    S. Lüders

  17. V. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland

    B. K. Krämer

  18. Medizinische Klinik III, Universitätsklinikum Frankfurt, Frankfurt a.M., Deutschland

    S. Büttner

  19. Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Hannover, Deutschland

    F. Limbourg

  20. Institut für Luft- und Raumfahrtmedizin, Deutsches Zentrum für Luft- und Raumfahrt, Köln, Deutschland

    J. Jordan

  21. Nierenzentrum Wiesbaden, Wiesbaden, Deutschland

    O. Vonend

  22. Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland

    H.-G. Predel

  23. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA

    F. Mahfoud

Authors
  1. M. Koziolek
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  2. J. Beige
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  3. M. Wallbach
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  4. D. Zenker
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  5. G. Henning
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  6. M. Halbach
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  7. N. Mader
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  8. F. Mahfoud
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  9. G. Schlieper
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  10. V. Schwenger
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  11. M. Hausberg
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  12. J. Börgel
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  13. M. Lodde
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  14. M. van der Giet
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  15. J. Müller-Ehmsen
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  16. J. Passauer
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  17. S. Parmentier
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  18. S. Lüders
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  19. B. K. Krämer
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  20. S. Büttner
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  21. F. Limbourg
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  22. J. Jordan
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  23. O. Vonend
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  24. H.-G. Predel
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  25. H. Reuter
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Corresponding author

Correspondence to M. Koziolek.

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Interessenkonflikt

H. Reuter, M. Halbach, M. Koziolek, M. Wallbach und J. Börgel erhielten Forschungsunterstützung von CVRx. H. Reuter, M. Koziolek und J. Müller-Ehmsen sind Mitglieder im Steuerungskomitee der BAROSTIM-NEO™-Registerstudien. H. Reuter, M. Halbach, M. Koziolek, J. Beige, N. Mader und J. Müller-Ehmsen erhielten Vortragshonorare von CVRx. D. Zenker, G. Henning, F. Mahfoud, G. Schlieper, V. Schwenger, M. Hausberg, M. Lodde, M. van der Giet, J. Passauer, S. Parmentier, S. Lüders, B.K. Krämer, S. Büttner, F. Limbourg, J. Jordan, O. Vonend und H.-G. Predel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Der Entschluss zum vorliegenden Konsensuspapier ergab sich auf dem 39. Wissenschaftlichen Kongress der Deutschen Hochdruckliga (DHL). Die Konsensusgruppe umfasst Mitglieder der Kommission Interventionelle Hochdrucktherapie (M. Hausberg, J. Jordan, F. Mahfoud, O. Vonend) und der Sektion Hochdruckdiagnostik (S. Lüders) der DHL sowie der AG Herz und Niere der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Nephrologie (DGfN) (F. Mahfoud, H. Reuter, G. Schlieper, V. Schwenger). Darüber hinaus besteht inhaltlich keine Beziehung zu Fachgesellschaften oder zur DHL. Weitere Mitglieder der Konsensusgruppe wurden aus den Kliniken und Arbeitsgruppen mit großer Erfahrung in der Therapie mit Barorezeptorstimulation und aus verschiedenen Fachbereichen großer Hypertoniezentren rekrutiert.

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Koziolek, M., Beige, J., Wallbach, M. et al. Barorezeptorakivierungstherapie bei therapierefraktärer Hypertonie: Indikation und Patientenselektion. Internist 58, 1114–1123 (2017). https://doi.org/10.1007/s00108-017-0308-y

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