Long-term sustained BP reductions with baroreflex activation therapy
Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy Results of the 6-Year Open Follow-UpLiterature - de Leeuw PW, Bisognano JD, Bakris GL, et al. - Hypertension 2017
- Patients who discontinued therapy during the first year, had a significantly higher BP at baseline compared with those who continued for a longer time (SBP: 190±24 mmHg vs. 178±23 mm g; DBP: 110±13 mmHg vs. 103±16 mmHg; both P<0.01).
- Over the 6-year period, SBP decreased from 179±24 mmHg to 144±28 mmHg (P<0.0001), and DBP decreased from 103±16 mmHg to 85±18 mmHg (P<0.0001).
- Heart rate was reduced from 74±15 beats/min to 71±13 beats/min (P<0.02).
- Pulse pressure was reduced from 76±19 to 59±17 mmHg (P<0.0001).
- The greatest effect on BP was evident in the early phase after implantation of the device.
- BP reduction did not correlate with age, BMI, or the number of medications taken before BAT. Race, smoking status, the presence or absence of DM, CAD, or a previous stroke, or the use of a MRA or any other type of antihypertensive drug had no effect on the response to BAT.
- The greatest BP reductions were observed in patients with congestive HF, who had significantly higher pre-treatment pressures. In HFpEF patients, the BP reduction was 46/24 mmHg, compared with the overall mean of 32/16 mmHg (P<0.05).
- Patients with isolated systolic hypertension (ISH) showed less pronounced reductions in SBP (−23±7 mmHg), DBP (−8±2 mmHg), and HR (0±1 beats/min), compared with those without ISH.
- 42% of patients had normalised their BP (SBP <140 mmHg and DBP <90 mmHg) at the end of the first year of follow-up.
- The proportion of patients on target varied between 49% and 54% over the entire follow-up period.
- There were 26 non-responders (SBP reduction <10 mmHg).
- In 27% of patients the number of medications fell from a median of 6 to a median of 3, in 34% of patients (34%) medication use remained stable at a median of 5, and in 39% of patients it increased from a median of 5 to a median of 7.
- Except for 1 stroke, all complications resolved without residual effects.
In treatment-resistant hypertensive patients, baroreflex activation therapy lowers BP in the long-term, particularly in those with HF and preserved ejection fraction. These data suggest that BAT may become an alternative therapeutic option for resistant hypertension in clinical practice.