Physicians' Academy for Cardiovascular Education

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-Up

de Leeuw PW, Bisognano JD, Bakris GL, et al. - Hypertension 2017

Background

Baroreflex activation therapy (BAT), through electric stimulation of the carotid sinus, leads to significant and sustained reductions of BP in patients with resistant hypertension [1-4]. This therapeutic method has, however, not been introduced into clinical practice, since it is invasive, and there is uncertainty about the long-term sustained efficacy.

In this analysis, the follow-up results of the 3 studies that evaluated BAT are described. The 3 Studies were the US Rheos Feasibility Trial, the DEBuT-HT Trial, and the Rheos Pivotal Trial. Data of 383 patients were available for analysis, of whom 143 had completed 5-years of follow-up, and 48 of 6 years (median follow-up: 5 years). In all 3 trials, the first-generation Rheos system was used, consisting of an implantable pulse generator and leads that were tunnelled subcutaneously and attached to each carotid sinus. Patients were seen at regular intervals, and stimulation parameters were individually adjusted to optimize treatment. Patients were either stimulated at one side (left or right) or bilaterally, depending on which produced the greatest response.

Main results

Conclusion

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.

References

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