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baroreflex activation therapy

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https://www.readbyqxmd.com/read/28377560/recent-advances-in-the-pathophysiology-of-arterial-hypertension-potential-implications-for-clinical-practice
#1
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
#2
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
#3
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...
March 20, 2017: Hypertension
https://www.readbyqxmd.com/read/28320848/long-term-follow-up-of-baroreflex-activation-therapy-in-resistant-hypertension-another-piece-of-the-puzzle
#4
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-dynamic-characteristics-of-the-carotid-sinus-baroreflex-in-normotensive-or-spontaneously-hypertensive-rats
#5
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 (baroreflex activation therapy) 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)...
March 8, 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
#6
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
#7
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
#8
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
#9
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
#10
EDITORIAL
Niv Ad
No abstract text is available yet for this article.
July 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
#11
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
https://www.readbyqxmd.com/read/27854009/autonomic-modulation-with-baroreflex-activation-therapy-in-heart-failure
#12
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...
December 2016: Current Heart Failure Reports
https://www.readbyqxmd.com/read/27777356/prolonged-baroreflex-activation-abolishes-salt-induced-hypertension-after-reductions-in-kidney-mass
#13
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...
December 2016: Hypertension
https://www.readbyqxmd.com/read/27754280/hw-03-4-carotid-baroreflex-activation-therapy
#14
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
#15
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
#16
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
#17
REVIEW
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...
October 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27643277/hw-03-4-carotid-baroreflex-activation-therapy
#18
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
#19
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
#20
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
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