Baroreflex activation therapy for treating resistant hypertension and heart failure

Abstract

Chronic baroreflex activation therapy (BAT) has demonstrated long-term blood pressure reductions in a resistant hypertensive population using a first generation system. A second generation system, the Barostim neo, has recently shown comparable chronic blood pressure reductions at 6 months while advancing the safety profile of the therapy. Furthermore, data from studies in heart failure patients suggest BAT may be a promising therapy for heart failure. These early successes have led to the initiation of larger-scale, randomized, controlled trials in both disease populations. I. INTRODUCTION Baroreflex activation therapy (BAT), a unique treatment for cardiovascular dysfunction, delivers electrical stimulation to the carotid sinus to elicit the intrinsic baroreflex depressor response, thereby normalizing sympatho-vagal balance. Chronic BAT with a first generation system produced significant and durable reductions in blood pressure (BP) in a resistant hypertension (HTN) population.(1) BAT has also been proposed as a therapy for heart failure (HF) because of its multiple cardiovascular benefits.(2) This overview summarizes results from studies with an advanced second generation system for BAT that demonstrate the promise of BAT for both resistant HTN and HF. II. THE BAROSTIM NEO SYSTEM The second generation Barostim neo system employs a unilaterally-implanted miniaturized electrode to facilitate a minimally invasive procedure. The disk-shaped electrode is sutured to the right carotid sinus adventitia and the pulse generator is implanted subcutaneously in the ipsilateral pectoral region. The intensity of stimulation is controlled via radiofrequency telemetry from an external, laptop computer- based programming system. III. RESISTANT HYPERTENSION