Abstract
SummaryAnimal and human data indicate pathological afferent signaling emanating from the carotid body that drives sympathetically mediated elevations in blood pressure in conditions of hypertension. This first-in-man, proof-of-principle study tested the safety and feasibility of unilateral carotid body resection in 15 patients with drug-resistant hypertension. The procedure proved to be safe and feasible. Overall, no change in blood pressure was found. However, 8 patients showed significant reductions in ambulatory blood pressure coinciding with decreases in sympathetic activity. The carotid body may be a novel target for treating an identifiable subpopulation of humans with hypertension.
Highlights
On the proportion of these patients that showed a response in blood pressure (BP), the hypoxic ventilatory response (HVR), and muscle sympathetic nerve activity (MSNA)
One of the events occurred shortly after the carotid bodies (CBs) removal procedure, and this event was judged by the Clinical Events Committee (CEC) to be “possibly related” to the unilateral removal of the CB
The CEC felt, that given that sleep-disordered breathing (SDB) was a pre-existing disease in this patient and the apnea-hypopnea index increased from 20 events/h at baseline to 74 events/h 3 months post-carotid body removal, worsening SDB should be noted as an adverse event
Summary
First prospective feasibility and safety clinical trial on unilateral CB resection for the treatment of high blood pressure. In drug-resistant patients with hypertension, unilateral CB resection was feasible and safe. Unilateral CB resection lowered blood pressure by 26 mm Hg in 57% of patients with drug-resistant hypertension associated with a reduction in muscle sympathetic nerve activity and its baroreceptor reflex control. Dr Abdala has served as a consultant for Neurolixis Inc
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