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baroreflex activation therapy

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https://www.readbyqxmd.com/read/28816745/restoration-of-normal-sympathetic-neural-function-in-heart-failure-following-baroreflex-activation-therapy-final-43-month-study-report
#1
Raffaella Dell'Oro, Edoardo Gronda, Gino Seravalle, Giuseppe Costantino, Luca Alberti, Barbara Baronio, Tiziana Staine, Emilio Vanoli, Giuseppe Mancia, Guido Grassi
BACKGROUND: Baroreflex activation therapy (BAT) exerts in severe heart failure sympathoinhibitory effects, improving clinical variables and reducing hospitalization rate. The current follow-up study was aimed at determining the long-term effects of BAT, assessing whether BAT in heart failure allows to restore physiological levels of sympathetic function. METHODS: Seven patients out of the 11 heart failure patients aged 66.5 ± 3 years (mean ± SEM) in New York Heart Association Class III with left ventricular ejection fraction 40% or less and impaired functional capacity recruited in the study survived at the final follow-up (43...
August 14, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28737621/baroreflex-activation-therapy-a-new-approach-to-the-management-of-advanced-heart-failure-with-reduced-ejection-fraction
#2
Edoardo Gronda, Darrel Francis, Faiez Zannad, Christian Hamm, Josep Brugada, Emilio Vanoli
: Chronic heart failure is a common clinical condition characterized by persistent excessive sympathetic nervous system activation. The derangement of the sympathetic activity has relevant implications for disease progression and patient survival. Aiming to positively impact patient outcome, autonomic nervous system modulatory therapies have been developed and tested in animal and clinical studies. As a general gross assumption, direct vagal stimulation and baroreflex activation are considered equivalent. This assumption does not take into account the fact that direct cervical vagal nerve stimulation involves activation of both afferent and efferent fibers innervating not only the heart, but the entire visceral system, leading to undesired responses to and from this compartment...
September 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28702747/management-of-supine-hypertension-complicating-neurogenic-orthostatic-hypotension
#3
Jacquie Baker, Kurt Kimpinski
Neurogenic orthostatic hypotension (NOH) can be present in a number of disorders, including synucleinopathies, autoimmune disorders, and various genetic disorders. All are characterized by defective norepinephrine release from sympathetic terminals upon standing, resulting in impaired vasoconstriction. NOH is defined as a drop in systolic blood pressure ≥20 mmHg or diastolic blood pressure ≥10 mmHg, or both, within 3 minutes of standing or head up-tilt at a minimum of 60°. However, approximately 50% of patients have associated supine hypertension, which greatly complicates treatment...
August 2017: CNS Drugs
https://www.readbyqxmd.com/read/28642732/autonomic-function-impairment-and-brain-perfusion-deficit-in-parkinson-s-disease
#4
Wei-Che Lin, Pei-Chin Chen, Chih-Cheng Huang, Nai-Wen Tsai, Hsiu-Ling Chen, Hung-Chen Wang, Kun-Hsien Chou, Meng-Hsiang Chen, Yi-Wen Chen, Cheng-Hsien Lu
INTRODUCTION: Autonomic disorders have been recognized as important Parkinson's disease (PD) components. Some vulnerable structures are related to the central autonomic network and have also been linked to autonomic function alterations. The aims of the study are to evaluate the severity of the autonomic dysfunction and the cortical hypoperfusion using arterial spin labeling (ASL) MRI. And then, possible relationships of significant between-group differences in perfusion pattern to clinical variables and autonomic functions were examined to determine the pharmaceutical effects of dopaminergic treatment on cerebral blood flow (CBF) in patients with PD...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28595464/the-effects-of-baroreflex-activation-therapy-on-blood-pressure-and-sympathetic-function-in-patients-with-refractory-hypertension-the-rationale-and-design-of-the-nordic-bat-study
#5
Daniel Gordin, Fadl Elmula M Fadl Elmula, Bert Andersson, Anders Gottsäter, Johan Elf, Thomas Kahan, Kent Lodberg Christensen, Pirkka Vikatmaa, Leena Vikatmaa, Thomas Bastholm Olesen, Per-Henrik Groop, Michael Hecht Olsen, Ilkka Tikkanen
OBJECTIVE: To explore the effects of baroreflex activation therapy (BAT) on hypertension in patients with treatment resistant or refractory hypertension. METHODS: This investigator-initiated randomized, double-blind, 1:1 parallel-design clinical trial will include 100 patients with refractory hypertension from 6 tertiary referral hypertension centers in the Nordic countries. A Barostim Neo System will be implanted and after 1 month patients will be randomized to either BAT for 16 months or continuous pharmacotherapy (BAT off) for 8 months followed by BAT for 8 months...
June 8, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28557555/effect-of-obstructive-sleep-apnea-on-the-response-to-hypertension-therapy
#6
Michael G Ziegler, Milos Milic, Xiaojiong Lu, Munir Gharaibeh, Hamzeh Elayan
Obstructive sleep apnea (OSA) often precedes cardiovascular disease, partly due to treatment resistant hypertension. The nocturnal apneas of OSA trigger increased sympathetic nervous discharge during both sleep and wakefulness. Apneas also trigger cardiac release of the endogenous diuretic atrial natriuretic peptide. We hypothesized that treatment of the excess sympathetic nervous activity of OSA with a β1 blocker would lower 24 h blood pressure (BP) more than diuretic therapy. Subjects with OSA associated hypertension received 2 weeks of placebo followed by the β1 blocker nebivolol or hydrochlorothiazide (HCTZ) for 6 weeks in a blinded crossover study...
2017: Clinical and Experimental Hypertension: CHE
https://www.readbyqxmd.com/read/28554698/effects-of-carotid-baroreceptor-stimulation-on-retinal-arteriole-remodeling-evaluated-with-adaptive-optics-camera-in-resistant-hypertensive-patients
#7
A Gallo, D Rosenbaum, C Kanagasabapathy, X Girerd
BACKGROUND AND AIM: Baroreceptor activation therapy (BAT) leads to a decrease in blood pressure (BP) in patients affected by resistant hypertension (RH) by reducing sympathetic outflow. This study aimed at evaluating the effects of BAT on RH patients' retinal arteriolar microvasculature, a territory devoid of adrenergic innervation. PATIENTS AND METHODS: Five patients defined as affected by RH after excluding secondary causes of hypertension and based on number of antihypertensive treatments, underwent the implantation of Barostim™ neo™...
June 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28543399/baroreceptor-stimulation-in-a-patient-with-preexisting-subcutaneous-implantable-cardioverter-defibrillator
#8
Kay F Weipert, Jens Andrick, Ritvan Chasan, Christopher Gemein, Astrid Most, Christian W Hamm, Damir Erkapic, Joern Schmitt
BACKGROUND: Many patients with severe heart failure (HF) have an indication for baroreflex activation therapy (BAT) and an ICD. Concerns about device-device interactions were addressed in a study with small sample size that concluded combined BAT and ICD therapy is safe. There are no published data, however, concerning device-device interactions between BAT and a subcutaneous ICD (S-ICD). Since BAT frequently interferes with surface ECG recordings there are doubts about compatibility of BAT and S-ICD devices...
May 24, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28456134/improvement-in-baroreflex-control-of-renal-sympathetic-nerve-activity-in-obese-sprague-dawley-rats-following-immunosuppression
#9
S A Khan, M Z A Sattar, N A Abdullah, H A Rathore, A Ahmad, M H Abdulla, E J Johns
AIM: This investigation explored the hypothesis that in obesity an inflammatory response in the kidney contributed to a renal nerve-dependent blunting of the baroreflex regulation of renal sympathetic nerve activity. METHODS: Rats received a normal (12% kcal) or high-fat (45% kcal) diet for 8 weeks plus daily injections of vehicle (0.9% NaCl i.p) or tacrolimus (0.25 mg kg(-1) day(-1) i.p) from weeks 3-8. Following anaesthesia, left renal sympathetic nerve activity was recorded, baroreflex gain curves were generated, by infusing phenylephrine and sodium nitroprusside, and cardiopulmonary baroreceptors challenged by infusing a saline load...
April 29, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/28377560/recent-advances-in-the-pathophysiology-of-arterial-hypertension-potential-implications-for-clinical-practice
#10
Dagmara Hering, Andrzej Trzebski, Krzysztof Narkiewicz
Hypertension remains a major and growing public health problem associated with the greatest global rate of cardiovascular morbidity and mortality. Although numerous factors contribute to poor control of blood pressure (BP) and to pseudoresistance (eg, unawareness, lifestyle habits, nonadherence to medication, insufficient treatment, drug‑induced hypertension, undiagnosed secondary causes), true resistant hypertension (RH) is reported in 10.1% of patients treated for elevated BP. While the mechanisms underlying RH remain complex and not entirely understood, sympathetic activation involved in the pathophysiology of hypertension, disease progression, and adverse complications is further augmented in patients with drug‑resistant hypertension...
March 1, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28360882/vestibular-activation-habituates-the-vasovagal-response-in-the-rat
#11
Bernard Cohen, Giorgio P Martinelli, Yongqing Xiang, Theodore Raphan, Sergei B Yakushin
Vasovagal syncope is a significant medical problem without effective therapy, postulated to be related to a collapse of baroreflex function. While some studies have shown that repeated static tilts can block vasovagal syncope, this was not found in other studies. Using anesthetized, male Long-Evans rats that were highly susceptible to generation of vasovagal responses, we found that repeated activation of the vestibulosympathetic reflex (VSR) with ±2 and ±3 mA, 0.025 Hz sinusoidal galvanic vestibular stimulation (sGVS) caused incremental changes in blood pressure (BP) and heart rate (HR) that blocked further generation of vasovagal responses...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28320856/sustained-reduction-of-blood-pressure-with-baroreceptor-activation-therapy-results-of-the-6-year-open-follow-up
#12
RANDOMIZED CONTROLLED TRIAL
Peter W de Leeuw, John D Bisognano, George L Bakris, Mitra K Nadim, Hermann Haller, Abraham A Kroon
Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up...
May 2017: Hypertension
https://www.readbyqxmd.com/read/28320848/long-term-follow-up-of-baroreflex-activation-therapy-in-resistant-hypertension-another-piece-of-the-puzzle
#13
Sebastian Ewen, Michael Böhm, Felix Mahfoud
No abstract text is available yet for this article.
March 20, 2017: Hypertension
https://www.readbyqxmd.com/read/28274940/aortic-depressor-nerve-stimulation-does-not-impede-the-dynamic-characteristics-of-the-carotid-sinus-baroreflex-in-normotensive-or-spontaneously-hypertensive-rats
#14
Toru Kawada, Michael J Turner, Shuji Shimizu, Masafumi Fukumitsu, Atsunori Kamiya, Masaru Sugimachi
Recent clinical trials in patients with drug-resistant hypertension indicate that electrical activation of the carotid sinus baroreflex can reduce arterial pressure (AP) for more than a year. To examine whether the electrical stimulation from one baroreflex system impedes normal short-term AP regulation via another unstimulated baroreflex system, we electrically stimulated the left aortic depressor nerve (ADN) while estimating the dynamic characteristics of the carotid sinus baroreflex in anesthetized normotensive Wistar-Kyoto (WKY; n = 8) rats and spontaneously hypertensive rats (SHR; n = 7)...
May 1, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
https://www.readbyqxmd.com/read/28267133/recent-advances-in-the-pathophysiology-of-arterial-hypertension-potential-implications-for-clinical-practice
#15
Dagmara Hering, Andrzej Trzebski, Krzysztof Narkiewicz
Hypertension remains a major and growing public health problem associated with the greatest proportion of global cardiovascular (CV) morbidity and mortality. Although numerous factors contribute to poor blood pressure (BP) control and pseudo-resistance (i.e. unawareness, life-style habits, non-adherence to medication, insufficient treatment, drug-induced hypertension, undiagnosed secondary causes etc.), it is reported that true resistant hypertension (RH) is found in 10.1 % of patients treated for elevated BP...
March 1, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28243928/pathophysiology-and-potential-non-pharmacologic-treatments-of-obesity-or-kidney-disease-associated-refractory-hypertension
#16
REVIEW
Thierry H Le Jemtel, William Richardson, Rohan Samson, Abhishek Jaiswal, Suzanne Oparil
PURPOSE OF REVIEW: The review assesses the role of non-pharmacologic therapy for obesity and chronic kidney disease (CKD) associated refractory hypertension (rf HTN). RECENT FINDINGS: Hypertensive patients with markedly heightened sympathetic nervous system (SNS) activity are prone to develop refractory hypertension (rfHTN). Patients with obesity and chronic kidney disease (CKD)-associated HTN have particularly heightened SNS activity and are at high risk of rfHTN...
February 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28185122/multidisciplinary-approach-in-the-treatment-of-resistant-hypertension
#17
REVIEW
S A Potthoff, O Vonend
With its high prevalence and the eminent number of undetected or poorly controlled patients, the management of arterial hypertension is still a challenging task. Uncontrolled blood pressure is the major adjustable risk factor for cardiovascular end organ damage for coronary heart disease, heart failure, stroke, and renal disease. Patients with resistant hypertension often need a multidisciplinary approach in order to control their blood pressure sustainably. In cooperation with hypertension specialists, the underlying cause for therapy resistance should be evaluated...
January 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28065708/an-exploratory-propensity-score-matched-comparison-of-second-generation-and-first-generation-baroreflex-activation-therapy-systems
#18
Rolf Wachter, Marcel Halbach, George L Bakris, John D Bisognano, Hermann Haller, Joachim Beige, Abraham A Kroon, Mitra K Nadim, Eric G Lovett, Jill E Schafer, Peter W de Leeuw
Baroreflex activation therapy (BAT) is a device-based therapy for patients with treatment-resistant hypertension. In a randomized, controlled trial, the first-generation system significantly reduced blood pressure (BP) versus sham. Although an open-label validation study of the second-generation system demonstrated similar BP reductions, controlled data are not presently available. Therefore, this investigation compares results of first- and second-generation BAT systems. Two cohorts of first-generation BAT system patients were generated with propensity matching to compare against the validation group of 30 second-generation subjects...
December 16, 2016: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/28043439/baroreflex-activation-therapy-for-patients-with-heart-failure-and-low-ejection-fraction-is-safe-and-effective
#19
EDITORIAL
Niv Ad
No abstract text is available yet for this article.
2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28043438/surgical-experience-and-long-term-results-of-baroreflex-activation-therapy-for-heart-failure-with-reduced-ejection-fraction
#20
RANDOMIZED CONTROLLED TRIAL
Fred A Weaver, William T Abraham, William C Little, Christian Butter, Anique Ducharme, Marcel Halbach, Didier Klug, Eric G Lovett, Navid Madershahian, Jochen Müller-Ehmsen, Jill E Schafer, Michele Senni, Vijay Swarup, Rolf Wachter, Michael R Zile
The purpose of this publication is to describe the intraoperative experience along with long-term safety and efficacy of the second-generation baroreflex activation therapy (BAT) system in patients with heart failure (HF) and reduced ejection fraction HF (HFrEF). In a randomized trial of New York Heart Association Class III HFrEF, 140 patients were assigned 1:1 to receive BAT plus medical therapy or medical therapy alone. Procedural information along with safety and efficacy data were collected and analyzed over 12 months...
July 2016: Seminars in Thoracic and Cardiovascular Surgery
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