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baroreflex activation therapy

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https://www.readbyqxmd.com/read/27854009/autonomic-modulation-with-baroreflex-activation-therapy-in-heart-failure
#1
REVIEW
Edoardo Gronda, Emilio Vanoli
Baroreflex activation therapy (BAT) produces a central inhibition of cardiac sympathetic outflow and, concomitantly, an increased cardiac vagal activity via a physiological reflex pathway. In a pilot study in 11 patients with NYHA class III heart failure (HF), BAT produced a persistent significant reduction of muscle sympathetic nerve activity over a 21-month follow-up and a dramatic decrease in the number and length of hospitalizations. In a multinational, prospective, randomized, parallel-controlled, clinical trial in 146 NYHA functional class III HF, BAT produced a significant N-terminal pro-brain natriuretic peptide reduction (p = 0...
November 16, 2016: Current Heart Failure Reports
https://www.readbyqxmd.com/read/27777356/prolonged-baroreflex-activation-abolishes-salt-induced-hypertension-after-reductions-in-kidney-mass
#2
Drew A Hildebrandt, Eric D Irwin, Thomas E Lohmeier
Chronic electric activation of the carotid baroreflex produces sustained reductions in sympathetic activity and arterial pressure and is currently being evaluated for therapy in patients with resistant hypertension. However, patients with significant impairment of renal function have been largely excluded from clinical trials. Thus, there is little information on blood pressure and renal responses to baroreflex activation in subjects with advanced chronic kidney disease, which is common in resistant hypertension...
October 24, 2016: Hypertension
https://www.readbyqxmd.com/read/27754280/hw-03-4-carotid-baroreflex-activation-therapy
#3
Teba Alnima
Electrical carotid baroreflex activation therapy is an emerging device-based treatment for patients with treatment-resistant hypertension. Its blood pressure lowering effect has been demonstrated in several animal and human studies. In addition, this treatment has showed its prolonged effect over the long-term. The main mechanism of the blood pressure reduction during this therapy is by inhibition of the sympathetic outflow. Yet the question arises whether the inhibition of central sympathetic activity is sufficient to be the sole mechanism behind the sustained reduction in blood pressure...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#4
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753836/sy-05-2-progression-of-hypertensive-heart-disease-new-therapeutic-approach
#5
Masatsugu Horiuchi
Hypertensive patients have greater chances of such cardiovascular events as stroke, coronary heart disease, heart or renal failure, peripheral artery disease, and dementia. It is also well recognized that diabetes increases the cardiovascular risks in concert with hypertension. Therefore, main goals for an innovation of anti-hypertensive therapy would be to achieve further risk reduction by targeting the functional, metabolic, and structural alterations associated with hypertension. Professors Dzau and Braunwald et al proposed the concept of "the cardiovascular disease continuum" in 1991, and that hypertension may trigger the chain of events, leading to end-stage heart disease; however, this concept was quite new at that time, and there was some discussion whether "the cardiovascular disease continuum" is true or not...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27671866/device-therapies-for-resistant-hypertension
#6
Dagmara Hering, Carl Schultz, Markus P Schlaich
PURPOSE: Resistant hypertension (RH) is a major and growing public health problem. While noncompliance to antihypertensive medication is a major concern in RH patients, it is estimated that even with adequate multi-drug regimens, approximately 10% of patients diagnosed with hypertension fulfill the criteria of true RH. Patients with sustained blood pressure (BP) elevation display high risk for development of target organ damage and associated cardiovascular morbidity and mortality. While optimized pharmacologic therapy, including the use of mineralocorticoid receptor antagonists to guideline-based antihypertensive drug therapy, is effective for improving BP control in this patient cohort, a sizable proportion of RH patients' BP remains uncontrolled, and alternative therapeutic strategies are warranted...
September 23, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27643277/hw-03-4-carotid-baroreflex-activation-therapy
#7
Teba Alnima
Electrical carotid baroreflex activation therapy is an emerging device-based treatment for patients with treatment-resistant hypertension. Its blood pressure lowering effect has been demonstrated in several animal and human studies. In addition, this treatment has showed its prolonged effect over the long-term. The main mechanism of the blood pressure reduction during this therapy is by inhibition of the sympathetic outflow. Yet the question arises whether the inhibition of central sympathetic activity is sufficient to be the sole mechanism behind the sustained reduction in blood pressure...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642926/br-04-1management-of-treatment-resistant-hypertension
#8
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642889/sy-05-2-progression-of-hypertensive-heart-disease-new-therapeutic-approach
#9
Masatsugu Horiuchi
Hypertensive patients have greater chances of such cardiovascular events as stroke, coronary heart disease, heart or renal failure, peripheral artery disease, and dementia. It is also well recognized that diabetes increases the cardiovascular risks in concert with hypertension. Therefore, main goals for an innovation of anti-hypertensive therapy would be to achieve further risk reduction by targeting the functional, metabolic, and structural alterations associated with hypertension. Professors Dzau and Braunwald et al proposed the concept of "the cardiovascular disease continuum" in 1991, and that hypertension may trigger the chain of events, leading to end-stage heart disease; however, this concept was quite new at that time, and there was some discussion whether "the cardiovascular disease continuum" is true or not...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27561790/increased-sympathetic-nerve-activity-and-reduced-cardiac-baroreflex-sensitivity-in-rheumatoid-arthritis
#10
Ahmed M Adlan, Julian F R Paton, Gregory Y H Lip, George D Kitas, James P Fisher
Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with increased cardiovascular morbidity/mortality and an incompletely understood pathophysiology. In animal studies, central and blood-borne inflammatory cytokines that can be elevated in RA evoke pathogenic increases in sympathetic activity and reductions in baroreflex sensitivity (BRS). We hypothesised that muscle sympathetic nerve activity (MSNA) was increased and BRS decreased in RA. MSNA, blood pressure and heart rate (HR) were recorded in age- and sex-matched RA-normotensive (n = 13), RA-hypertensive patients (RA-HTN; n = 17), normotensive (NC; n = 17) and hypertensive controls (HTN; n = 16)...
August 26, 2016: Journal of Physiology
https://www.readbyqxmd.com/read/27508843/-op-7d-01-safety-and-blood-pressure-effects-of-second-versus-first-generation-system-for-administering-baroreflex-activation-therapy
#11
R Wachter, M Halbach, G Bakris, J Bisognano, H Haller, J Beige, A A Kroon, M Nadim, E Lovett, J Schafer, P W de Leeuw
OBJECTIVE: To compare safety and blood pressure (BP) reductions obtained with first- and second-generation systems for administering baroreflex activation therapy (BAT) in patients with resistant hypertension, as well as to verify that BP reductions with active BAT are distinguishable from placebo and Hawthorne effects observed with sham control. DESIGN AND METHOD: Second-generation data were available from 30 patients implanted in a single-arm verification study...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27508576/-op-8d-02-first-in-man-treatment-of-severe-bp-variability-with-baroreflex-activation-therapy
#12
M D Lobo, M Y Adeel, C B Wolff, P O Julu, M Shah, D M Collier, M Saxena, C Floyd, T Brier, V Kapil, O Mukhtar, A Radunovic, N Sutcliffe, F Sharif
OBJECTIVE: Profound BP variability (BPV) is a major cause of cardiovascular morbidity and poor quality of life as there are no optimal pharmacological strategies to help patients. We hypothesised that in a patient with baroreflex dysfunction and preserved efferent baroreflex pathway, carotid sinus stimulation may help control BP, BPV and heart rate variability (HRV). DESIGN AND METHOD: A 52 year old man was referred with profound HR and BPV. Home SBPs were in a range of 60-250 mmHg and DBPs were 40-130 mmHg and heart rate (HR) of 60-200 bpm (confirmed with ABPM, see Figure) despite multiple medications including felodipine 30 mg daily, terazosin 16 mg daily, doxazosin 8 mg daily, bisoprolol 20 mg daily and butrans patch 17...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27495297/acute-arterial-baroreflex-mediated-changes-in-plasma-catecholamine-concentrations-in-a-chronic-rat-model-of-myocardial-infarction
#13
Toru Kawada, Tsuyoshi Akiyama, Meihua Li, Can Zheng, Michael J Turner, Mikiyasu Shirai, Masaru Sugimachi
While it may be predictable that plasma norepinephrine (NE) concentration changes with efferent sympathetic nerve activity (SNA) in response to baroreceptor pressure inputs, an exact relationship between SNA and plasma NE concentration remains to be quantified in heart failure. We examined acute baroreflex-mediated changes in plasma NE and epinephrine (Epi) concentrations in normal control (NC) rats and rats with myocardial infarction (MI) (n = 6 each). Plasma NE concentration correlated linearly with SNA in the NC group (slope: 2...
August 2016: Physiological Reports
https://www.readbyqxmd.com/read/27444637/baroreceptor-stimulation-for-resistant-hypertension
#14
Ayhan Yoruk, John D Bisognano, John P Gassler
Hypertension (HTN) is a worldwide epidemic. When untreated, HTN places patients at an elevated risk for several health conditions, including cardiovascular disease and end-organ damage. This effect is particularly pronounced in a subset of patients who experience treatment-resistant HTN despite the utilization of conventional medication and lifestyle interventions. For these challenging patients, ongoing research efforts continue to explore and develop novel nonpharmacologic therapies for resistant HTN. One such avenue is the regulation of the sympathetic nervous system, a large component of circulatory physiology...
July 21, 2016: American Journal of Hypertension
https://www.readbyqxmd.com/read/27390993/first-in-man-treatment-of-severe-blood-pressure-variability-with-baroreflex-activation-therapy
#15
Christopher N Floyd, Muhammad Y Adeel, Christopher B Wolff, Peter Julu, Mussadiq Shah, David J Collier, Manish Saxena, Tim Brier, Fu Ng, Vikas Kapil, Omar Mukhtar, Aleksandar Radunovic, Nurhan Sutcliffe, Faisal Sharif, Timothy O'Brien, Melvin D Lobo
No abstract text is available yet for this article.
October 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27381561/emerging-concepts-for-patients-with-treatment-resistant-hypertension
#16
REVIEW
Alfonso Eirin, Stephen C Textor, Lilach O Lerman
Treatment-resistant hypertension (TRH) is defined as elevated blood pressure despite treatment with three properly dosed antihypertensive drugs, and is associated with adverse cardiovascular and renal outcomes and increased mortality. Treatment of patients with TRH focuses on maximizing the doses of antihypertensive drugs and adding drugs with complementary mechanisms of action, including a combination of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, calcium channel blockers, and thiazide-like diuretics...
November 2016: Trends in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27370788/device-based-therapy-for-hypertension
#17
REVIEW
Fu L Ng, Manish Saxena, Felix Mahfoud, Atul Pathak, Melvin D Lobo
Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension...
August 2016: Current Hypertension Reports
https://www.readbyqxmd.com/read/27334011/baroreflex-activation-therapy-in-congestive-heart-failure-novel-findings-and-future-insights
#18
REVIEW
Guido Grassi, GianMaria Brambilla, Daniela Prata Pizzalla, Gino Seravalle
Congestive heart failure is characterized by hemodynamic and non-hemodynamic abnormalities, the latter including an activation of the sympathetic influences to the heart and peripheral circulation coupled with an impairment of baroreceptor control of autonomic function. Evidence has been provided that both these alterations are hallmark features of the disease with a specific relevance for the disease progression as well as for the development of life-threatening cardiac arrhythmias. In addition, a number of studies have documented in heart failure the adverse prognostic role of the sympathetic and baroreflex alterations, which both are regarded as major independent determinants of cardiovascular morbidity and mortality...
August 2016: Current Hypertension Reports
https://www.readbyqxmd.com/read/27293020/deep-and-future-insights-into-neuromodulation-therapies-for-heart-failure
#19
Takuya Kishi
Major pathophysiology of heart failure is an autonomic nervous system dysfunction as a result of excess sympathoexcitation and/or withdrawal of vagal nerve activity. Although we already have various pharmacological and non-pharmacological therapies for heart failure, survival of heart failure patients remains around 50%. To achieve further reductions in morbidity and mortality of heart failure, neuromodulations with devices, such as baroreflex activating therapy, vagal nerve stimulation, renal sympathetic denervation, spinal cord stimulation, and left cardiac sympathetic denervation, have been expected...
November 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27220533/effect-of-cardiac-cycle-synchronized-selective-vagal-stimulation-on-heart-rate-and-blood-pressure-in-rats
#20
Dennis T T Plachta, Josef Zentner, Debora Aguirre, Oscar Cota, Thomas Stieglitz, Mortimer Gierthmuehlen
INTRODUCTION: Activation of the baroreflex system through the selective vagal nerve stimulation (sVNS) may become a treatment option for therapy-resistant hypertension, which is a frequently observed problem in the antihypertensive therapy. In previous studies, we used continuous sVNS to lower blood pressure (BP) without major side effects in a rat model. As continuous stimulation is energy consuming and sVNS could be implemented in an antihypertensive stimulator, it was the aim of this study to investigate the efficacy of pulsatile, cardiac-cycle-synchronized sVNS (cssVNS) on the reduction of BP...
July 2016: Advances in Therapy
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