Universität zu Köln

Halbach, Marcel, Hickethier, Tilman ORCID: 0000-0001-9303-9470, Madershahian, Navid, Reuter, Hannes, Brandt, Mathias C., Hoppe, Uta C. and Mueller-Ehmsen, Jochen (2015). Acute on/off effects and chronic blood pressure reduction after long-term baroreflex activation therapy in resistant hypertension. J. Hypertens., 33 (8). S. 1697 - 1704. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1473-5598

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Abstract

Background: Baroreflex activation therapy (BAT) by electrical stimulation of baroreceptors at the carotid sinus is a promising therapeutic approach to reduce elevated blood pressure (BP). To assess the efficacy of long-term BAT, we investigated acute BP alterations after device deactivation and reactivation (on/off effects) in patients on chronic BAT, as well as chronic BP reductions. Method: Resistant hypertension patients (n = 17) were enrolled in an open-label, single-arm evaluation of unilateral BAT after exclusion of secondary hypertension. Initial eligibility criteria were SBP >= 140 mmHg, despite stable medical therapy with at least three antihypertensive drugs including at least one diuretic. For on/off testing, several office cuff BP measurements were performed: at rest with activated device, 4-6 min after deactivation, and 4-6 min after reactivation. Results: Before BAT, mean office cuff BP was 179 +/- 25 over 98 +/- 18 mmHg. At the time of on/off testing (15.1 +/- 8.7 months after initial activation and before deactivation), BP was reduced to 147 +/- 29 over 84 +/- 20 mmHg. On deactivation, SBP increased to 158 +/- 38 mmHg (P = 0.004) and DBP to 89 +/- 23 mmHg (P = 0.04). After reactivation, SBP decreased to 144 +/- 34 mmHg (P = 0.002 vs. deactivation) and DBP to 83 +/- 23 mmHg (P = 0.009). There was no correlation between duration of chronic BAT and systolic or diastolic acute on/off response. Conclusion: Unilateral BAT reduces BP in patients with resistant hypertension in the long term. There is a significant on/off effect on BP, supporting the efficacy of BAT. The acute on/off response to BAT does not depend on treatment duration. Thus, no evidence of tolerance over time to chronic BAT was found.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Halbach, Marcel UNSPECIFIED UNSPECIFIED UNSPECIFIED Hickethier, Tilman UNSPECIFIED orcid.org/0000-0001-9303-9470 UNSPECIFIED Madershahian, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Reuter, Hannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Brandt, Mathias C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoppe, Uta C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller-Ehmsen, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-397158
DOI:	10.1097/HJH.0000000000000586
Journal or Publication Title:	J. Hypertens.
Volume:	33
Number:	8
Page Range:	S. 1697 - 1704
Date:	2015
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1473-5598
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DOUBLE-BLIND; SPIRONOLACTONE; STIMULATION; SYSTEM Multiple languages Peripheral Vascular Disease Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/39715