Abstract
A significant number of hypertensive subjects fail to achieve adequate blood pressure control despite adherence to maximal doses of several antihypertensive drugs. In the same way although medical and device therapies continue to improve the clinical course of heart failure patients, morbidity, mortality and healthcare costs remain high. Electrical stimulation of the carotid sinus is a new interesting approach for the treatment of resistant hypertension and heart failure. The purpose of this paper is to overview the argument starting from physiological background and evaluating the clinical results obtained with this approach in these pathophysiological conditions.
Similar content being viewed by others
References
Hering D, Kara T, Kucharska W, Somers VK, Narkiewicz K. High-normal blood pressure is associated with increased resting sympathetic activity but normal responses to stress tests. Blood Press. 2013;22:183–7.
Mancia G, Grassi G, Giannattasio C, Seravalle G. Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension. 1999;34:724–8.
Grassi G, Seravalle G, Brambilla G, et al. Marked sympathetic activation and baroreflex dysfunction in true resistant hypertension. Int J Cardiol. 2014;177:1020–5.
Grassi G, Seravalle G, Mancia G. Left ventricular hypertrophy and sympathetic activity. Adv Exp Med Biol. 1997;432:173–9.
Hansen J, Victor RG. Direct measurement of sympathetic activity: new insights into disordered blood pressure regulation in chronic renal failure. Curr Opin Nephrol Hypertens. 1994;3:636–43.
Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819–23.
Hasking GJ, Esler MD, Jennings GL, Burton D, Johns JA, Korner PI. Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation. 1986;73:615–21.
Leimbach WN Jr, Wallin BG, Victor RG, Aylward PE, Sundlöf G, Mark AL. Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure. Circulation. 1986;73:913–9.
Grassi G, Seravalle G, Bertinieri G, et al. Sympathetic and reflex abnormalities in heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy. Clin Sci (Lond). 2001;101:141–6.
Go AS, Mozaffarian D, Roger VL, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–292.
Mancia G, Grassi G. Systolic and diastolic blood pressure control in antihypertensive drug trials. J Hypertens. 2002;20:1461–4.
Zanchetti A, Mancia G, Black HR, et al. Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension. J Hypertens. 2009;27:673–9.
Struijker-Boudier HA, Ambrosioni E, Holzgreve H, et al. The need for combination antihypertensive therapy to reach target blood pressures: what has been learned from clinical practice and morbidity-mortality trials? Int J Clin Pract. 2007;61:1592–602.
Waeber B, Volpe M, Ruilope LM, Schmieder RE. Diagnosis and treatment of resistant hypertension. Blood Press. 2014;23(4):193–9.
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403–19.
Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol. 2008;52:1749–57.
Chapman N, Dobson J, Wilson S, For the Anglo-Scandinavian Cardiac Outcomes Trial Investigators, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension. 2007;49:839–45.
Weber MA, Black H, Bakris G, et al. A selective endothelin-receptor antagonist to reduce blood pressure in patients with treatment-resistant hypertension: a randomized double-blind placebo-blind placebo-controlled trial. Lancet. 2009;374:1423–31.
Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373:1275–81.
Mohaupt MG, Schmidli J, Luft FC. Management of uncontrollable hypertension with a carotid sinus stimulation device. Hypertension. 2007;50:825–8.
Heusser K, Tank J, Engeli S, et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension. 2010;55:619–26.
Burgoyne S, Georgakopoulos D, Belenkie I, Tyberg JV. Systemic vascular effects of acute electrical baroreflex stimulation. Am J Physiol Heart Circ Physiol. 2014;307:H236–41.
Bisognano JD, Bakris G, Nadim MK, et al. 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. 2011;58:765–73.
Bakris GL, Nadim MK, Haller H, Lovett EG, Schafer JE, Bisognano JD. 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. 2012;6:152–8.
Hoppe UC, Brandt MC, Wachter R, et al. 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. 2012;6:270–6.
Brandt MC, Madershahian N, Velden R, Hoppe UC. Baroreflex activation as a novel therapeutic strategy for diastolic heart failure. Clin Res Cardiol. 2011;100:249–51.
McCubbin JW, Green JH, Page IH. Baroreceptor function in chronic renal hypertension. Circ Res. 1956;4:205–10.
Werner HR. The frequency-dependent nature of blood pressure regulation by the carotid sinus studied with an electrical analog. Circ Res. 1958;6:35–40.
Bilgutay A, Lillehei W. Treatment of hypertension with an implantable electronic device. JAMA. 1965;191:113–7.
Schwartz S, Griffith L, Neistadt A, et al. Chronic carotid sinus nerve stimulation in the treatment of essential hypertension. Am J Surg. 1967;114:5–15.
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.
Peters T, Koralewski H, Zerbst F. Search for optimal frequencies and amplitudes of therapeutic electrical carotid sinus nerve stimulation by application of the evolutionary strategy. Artif Organs. 1989;13:133–43.
Peters T, Koralewski H, Zerbst F. The principle of electrical carotid sinus nerve stimulation: a nerve pacemaker system for angina pectoris and hypertension therapy. Ann Biomed Eng. 1980;8:445–58.
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;358:101–10.
Parsonnet V, Myers GH, Holcomb WG, et al. Radio-frequency stimulation of the carotid baroreceptors in the treatment of hypertension. Surg Forum. 1966;17:125–7.
Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension. 2009;54:690–7.
Esler M. The sympathetic system and hypertension. Am J Hypertens. 2000;13:99S–105S.
Mancia G, Ludbrook J, Ferrari A, et al. Baroreceptor reflexes in human hypertension. Circ Res. 1978;43:170–7.
Lohmeier TE, Loheimer JR, Haque A, et al. Baroreflexes prevent neurally induced sodium retention in angiotensin hypertension. Am J Physiol Regul Integr Comp Physiol. 2000;279:R1437–48.
Lohmeier TE, Irwin E, Rossing M, et al. Prolonged activation of the baroreflex produces sustained hypotension. Hypertension. 2004;4:306–11.
Barrett CJ, Guild S, Ramchandra J, et al. Baroreceptor denervation prevents sympathoinhibition during angiotensin II-induced hypertension. Hypertension. 2005;46:1–5.
Lohmeier TE, Dwyer TM, Irwin ED, et al. Prolonged activation of the baroreflex abolishes obesity-induced hypertension. Hypertension. 2007;49:1307–14.
Schmidli J, Mohaupt M, Savolainen H, et al. Response to acute electrical activation of the carotid baroreflex is maintained in drug refractory hypertension. J Hypertens. 2005;23(suppl 2):S6.
Schmidli J, Savolainen H, Eckstein F, et al. Acute device-based blood pressure reduction: electrical activation of the carotid baroreflex in patients undergoing elective carotid surgery. Vascular. 2007;15:63–9.
Kroon A, Schmidli J, Scheffers I, et al. Chronically implanted system: 4-year data of Rheos DEBuT-HT Study in patients with resistant hypertension. J Hypertens. 2010;28(Suppl A):e441.
Scheffers I, Kroon AA, Schmidli J, et al. Novel baroreflex activation therapy in resistant hypertension: results of European Multicenter Feasibility Study. J Am Coll Cardiol. 2010;56:1254–8.
Scheffers I, Kroon AA, de Leeuw P. Renal hemodynamics during chronic therapy with electrical stimulation of the carotid sinus in humans. J Hypertens. 2008;26(suppl 1):S465.
Porter TR, Eckberg DL, Fritsch JM, et al. Autonomic pathophysiology in heart failure patients. Sympathetic-cholinergic interrelations. J Clin Invest. 1990;85:1362–71.
Grassi G, Seravalle G, Cattaneo BM, et al. Sympathetic activation and loss of reflex sympathetic control in mild congestive heart failure. Circulation. 1995;92:3206–11.
Ferguson DW, Abboud FM, Mark AL. Selective impairment of baroreflex-mediated vasoconstrictor responses in patients with ventricular dysfunction. Circulation. 1984;69:451–60.
Sabbah HN. Baroreflex activation for the treatment of heart failure. Curr Cardiol Rep. 2012;14:326–33.
Zucker IH, Hackley JF, Cornish KG, et al. Chronic baroreceptor activation enhances survival in dogs with pacing-induced heart failure. Hypertension. 2007;50:904–10.
Gronda E, Seravalle G, Brambilla G, et al. Chronic baroreflex activation effects on sympathetic nerve traffic, baro reflex function, and cardiac haemodynamics in heart failure: a proof-of-concept study. Eur J Heart Fail. 2014;16:977–83.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seravalle, G., Grassi, G. Carotid Baroreceptor Stimulation in Resistant Hypertension and Heart Failure. High Blood Press Cardiovasc Prev 22, 233–239 (2015). https://doi.org/10.1007/s40292-015-0083-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40292-015-0083-6