We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Chronic Electrical Activation of the Carotid Sinus Baroreflex by Implanted Electrodes for Blood Pressure Reduction in Man: First Experience in a Hypertensive Patient.
- Authors
Mohaup, M. G.; Savolainen, H.; Cain, C.; Frey, F. J.; Carrel, T.; Schmidl, J.
- Abstract
Objective: When blood pressure cannot be sufficiently controlled despite adherence to optimal drug treatment and nonpharmacological (life style) modifications, currently no other alternatives remain. Experimental studies provided evidence for sustained blood pressure reduction with chronic electrical activation of the carotid sinus baroreflex. A clinical trial has been initiated to investigate this approach in indicated patients. We report the first experience in a patient. Methods: Our first patient was a 56-y/o woman with a renal transplant due to hypertensive and diabetic nephropathy 8 years ago and a mean 24-h blood pressure of 178/102mmHg despite antihypertensive treatment with 5 different drugs including a diuretic and controlled compliance. Electrodes were chronically implanted at both carotid sinuses with electrical activation provided by a programmable, pectorally implanted pulse generator. The correct placement of the electrodes was supported by using a modified general anaesthesia, which maintained baroreflexes and facilitated intraoperative testing of the haemodynamic response. Results: The implantation procedure was well tolerated. Supine dose (voltage) response testing with the device programmed for bilateral activation indicated a drop by up to 70mmHg and 24mmHg of systolic and diastolic blood pressure, respectively. Postoperatively, the antihypertensive drug treatment remained unchanged. When a mild (low-voltage) 24-h activation was stopped for 30 min, the blood pressure changed from 178/77mmHg to 192/76mmHg. A subsequent dose response test after cessation of the prolonged activation resulted in a reduction by 38mmHg and by 8mmHg for systolic and diastolic blood pressure, respectively. Conclusions: These first data indicate that hypertensive blood pressures can be reduced with implantation of a device for electrical carotid sinus baroreflex activation. The acute dose response testing demonstrates reproducible efficacy. The so far limited experience also indicates a sustained blood pressure response 1-month beyond acute interventions. The data further confirm the feasibility of investigating this new therapeutic approach to uncontrolled hypertension in the ongoing clinical trial.
- Subjects
BLOOD pressure; CAROTID sinus; BAROREFLEXES; ELECTRODES; DIABETES
- Publication
Kidney & Blood Pressure Research, 2004, Vol 27, Issue 5/6, p299
- ISSN
1420-4096
- Publication type
Article