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Jami O, Oussama EA, Mohammed Z, Soulaymane I, Ilhaam BS, Tijani Y, Aziz E. Device's design and clinical perspectives for resistant hypertension therapy. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200240. [PMID: 38352851 PMCID: PMC10862014 DOI: 10.1016/j.ijcrp.2024.200240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Introduction Hypertension is the leading cause of death in the cardiovascular system. Indeed, untreated hypertension can affect one's general health, but medicine can help hypertensive people reduce their chance of developing high blood pressure. However, secondary hypertension remains an unresolved illness. Areas covered This review will go through the typical and unusual device-based therapies for resistant hypertension that have arisen in recent years. Further to that, the innovations developed in device-based RH treatment will be covered, as well as the research and studies assessing these novel technologies. Expert opinion The innovative device-based techniques that target resistant hypertension provide a potential therapy that has been backed by a number of studies and clinical trials, whereas pharmacological non-adherence and increased sympathetic activity are recognized to be the primary causes of resistant hypertension. Nevertheless, some limitations will be critical for the future of these RH systems, with the device's design and larger RCTs playing a significant role in determining whether a position in routine treatment could be warranted.
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Affiliation(s)
- Oussama Jami
- Mohammed V University in Rabat, High School of Technology in Salé; Materials, Energy and Acoustics Team, Rabat, Morocco
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - El Allam Oussama
- National High School of Arts and Crafts of Casablanca, Hassan II University of Casablanca, Morocco
| | - Zaki Mohammed
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - Imai Soulaymane
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - Ben Sahi Ilhaam
- Mohammed VI University of Health Sciences, Faculty of Medicine, Casablanca, Morocco
| | - Youssef Tijani
- Mohammed VI University of Health Sciences, Faculty of Medicine, Casablanca, Morocco
| | - Ettahir Aziz
- Mohammed V University in Rabat, High School of Technology in Salé; Materials, Energy and Acoustics Team, Rabat, Morocco
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Tsioufis PA, Theofilis P, Vlachakis PK, Dimitriadis K, Tousoulis D, Tsioufis K. Novel Invasive Methods as the Third Pillar for the Treatment of Essential Uncontrolled Hypertension. Curr Pharm Des 2023; 29:2780-2786. [PMID: 37641987 DOI: 10.2174/1381612829666230828142346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
Pharmacologic therapies remain the treatment of choice for patients with essential hypertension, as endorsed by international guidelines. However, several cases warrant additional modalities, such as invasive antihypertensive therapeutics. The major target of these interventions is the modulation of the sympathetic nervous system, which is a common pathophysiologic mechanism in essential hypertension. In this narrative review, we elaborate on the role of invasive antihypertensive treatments with a focus on renal denervation, stressing their potential as well as the drawbacks that prevent their widespread implementation in everyday clinical practice. In the field of renal denervation, several trials have shown significant and sustained reductions in the level of office and ambulatory blood pressure, regardless of the type of energy that was used (radiofrequency or ultrasound). Critically, renal denervation is considered a safe intervention, as evidenced by follow-up data from large clinical trials. Baroreflex activation therapy may result in enhanced parasympathetic nervous system activation, thus lowering blood pressure levels. Along the same lines, carotid body ablation could also produce a significant antihypertensive effect, which has not been tested in appropriately designed randomized trials. Moreover, cardiac neuromodulation therapy could prove efficacious by altering the duration of the atrioventricular interval in order to regulate the preload of the left ventricle and, therefore, lower blood pressure.
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Affiliation(s)
| | - Panagiotis Theofilis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Panayotis K Vlachakis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
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3
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Jami O, Tijani Y, Et-Tahir A. Device-Based Therapy for Resistant Hypertension: An Up-to-Date Review. High Blood Press Cardiovasc Prev 2022; 29:537-546. [PMID: 36178479 PMCID: PMC9523625 DOI: 10.1007/s40292-022-00539-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Hypertension is the major risk factor for cardiovascular morbidity and mortality. Matter of fact, untreated hypertension can worsen the overall health, whereas pharmacotherapy can play an important role in lowering the risk of high blood pressure in hypertensive patients. However, persistent uncontrolled hypertension remains an unsolved condition characterized by non-adherence to medication and increased sympathetic activity. This paper will review the non-pharmacological treatments for resistant hypertension (RH) that have emerged in recent years. In addition, the technologies developed in device-based RH therapy, as well as the clinical trials that support their use, will be discussed. Indeed, the novel device-based approaches that target RH present a promising therapy which has been supported by several studies and clinical trials, whereas drug non-adherence and high sympathetic activity are known to be the main causes of RH. Nevertheless, some additional aspects of these RH systems need to be tested in the near future, with a particular focus on the device’s design and availability of randomized controlled trials.
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Affiliation(s)
- Oussama Jami
- High School of Technology in Salé, Materials, Energy and Acoustics Team Rabat, Mohammed V University in Rabat, Rabat, Morocco. .,Biomedical Engineering Department, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Youssef Tijani
- Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Aziz Et-Tahir
- High School of Technology in Salé, Materials, Energy and Acoustics Team Rabat, Mohammed V University in Rabat, Rabat, Morocco
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Choudhury M, Kumar N, Chalil S, Abozguia K. Refractory hypertensive emergency associated with complete heart block resolved after permanent pacemaker implantation: A case report. Clin Case Rep 2022; 10:e5964. [PMID: 35765295 PMCID: PMC9207116 DOI: 10.1002/ccr3.5964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Severe hypertension sometimes improves with treatment of bradycardia but this phenomenon is under‐reported. Here, an elderly gentleman with complete heart block and a hypertensive emergency was refractory to medical therapies and blood pressure only improved following pacemaker implantation. We discuss the possible mechanisms relating to heart rate and artificial pacing.
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Affiliation(s)
| | - Narendra Kumar
- Lancashire Cardiac Centre, Blackpool Victoria Hospital Blackpool UK
| | - Shajil Chalil
- Lancashire Cardiac Centre, Blackpool Victoria Hospital Blackpool UK
| | - Khalid Abozguia
- Lancashire Cardiac Centre, Blackpool Victoria Hospital Blackpool UK
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5
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Lauder L, Mahfoud F. Pacemaker-Based Cardiac Neuromodulation Therapy for the Treatment of Hypertension: The New Kid on the Block. J Am Heart Assoc 2021; 10:e022622. [PMID: 34387121 PMCID: PMC8475037 DOI: 10.1161/jaha.121.022622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Saarland University Homburg/Saar Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Saarland University Homburg/Saar Germany
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6
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Kalarus Z, Merkely B, Neužil P, Grabowski M, Mitkowski P, Marinskis G, Erglis A, Kaźmierczak J, Sturmberger T, Sokal A, Pluta S, Gellér L, Osztheimer I, Malek F, Kolodzińska A, Mika Y, Evans SJ, Hastings HM, Burkhoff D, Kuck KH. Pacemaker-Based Cardiac Neuromodulation Therapy in Patients With Hypertension: A Pilot Study. J Am Heart Assoc 2021; 10:e020492. [PMID: 34387126 PMCID: PMC8475046 DOI: 10.1161/jaha.120.020492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In prior unblinded studies, cardiac neuromodulation therapy (CNT) employing a sequence of variably timed short and longer atrioventricular intervals yielded sustained reductions of systolic blood pressure (SBP) in patients with hypertension. The effects of CNT on SBP were investigated in this double-blind randomized pilot study. Methods and Results Eligible patients had daytime ambulatory SBP (aSBP) ≥130 mm Hg and office SBP ≥140 mm Hg despite taking ≥1 antihypertensive medication, and an indication for a dual-chamber pacemaker. Patients underwent Moderato device implantation, which was programmed as a standard pacemaker during a 1-month run-in phase. Patients whose daytime aSBP was ≥125 mm Hg at the end of this period were randomized (1:1, double blind) to treatment (CNT) or control (CNT inactive). The primary efficacy end point was the between-group difference of the change in 24-hour aSBP at 6 months. Of 68 patients initially enrolled and who underwent implantation with the Moderato system, 47 met criteria for study continuation and were randomized (26 treatment, 21 control). The mean age was 74.0±8.7 years, 64% were men, left ventricular ejection fraction was 59.2%±5.7%, and aSBP averaged 141.0±10.8 mm Hg despite the use of 3.3±1.5 antihypertensive medications; 81% had isolated systolic hypertension. Six months after randomization, aSBP was 11.1±10.5 mm Hg (95% CI, -15.2 to -8.1 mm Hg) lower than prerandomization in the treatment group compared with 3.1±9.5 mm Hg (-7.4 to 1.2 mm Hg) lower in controls, yielding a net treatment effect of 8.1±10.1 mm Hg (-14.2 to -1.9 mm Hg) (P=0.012). There were no Moderato device- or CNT-related adverse events. Conclusions CNT significantly reduced 24-hour aSBP in patients with hypertension with a clinical indication for a pacemaker. The majority of patients had isolated systolic hypertension, a particularly difficult group of patients to treat. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02837445.
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Affiliation(s)
- Zbigniew Kalarus
- Department of Cardiology DMS in ZabrzeMedical University of Silesia Katowice Poland
| | - Béla Merkely
- Heart and Vascular Center Semmelweis University Budapest Hungary
| | - Petr Neužil
- Department of Cardiology Na Homolce Hospital Prague Czech Republic
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology Medical University of Warsaw Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology Karol Marcinkowski University of Medical Sciences Poznań Poland
| | - Germanas Marinskis
- Department of Cardiovascular Diseases Centre for Cardiology and Angiology Vilnius University Vilnius Lithuania
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital University of Latvia Riga Latvia
| | | | - Thomas Sturmberger
- Interne 2 - Kardiologie, Angiologie & Interne Intensivmedizin Ordensklinikum Linz GmbH Elisabethinen Linz Austria
| | - Adam Sokal
- Department of Cardiology DMS in ZabrzeMedical University of Silesia Katowice Poland
| | - Slawomir Pluta
- Department of Cardiology DMS in ZabrzeMedical University of Silesia Katowice Poland
| | - László Gellér
- Heart and Vascular Center Semmelweis University Budapest Hungary
| | | | - Filip Malek
- Department of Cardiology Na Homolce Hospital Prague Czech Republic
| | | | | | | | - Harold M Hastings
- Division of Science, Mathematics and Computing Bard College at Simon's Rock Great Barrington MA.,Department of Physics and Astronomy Hofstra University Hempstead NY
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Jorbenadze A, Fudim M, Mahfoud F, Adamson PB, Bekfani T, Wachter R, Sievert H, Ponikowski PP, Cleland JGF, Anker SD. Extra-cardiac targets in the management of cardiometabolic disease: Device-based therapies. ESC Heart Fail 2021; 8:3327-3338. [PMID: 34002946 PMCID: PMC8318435 DOI: 10.1002/ehf2.13361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Heart failure (HF) does not occur in a vacuum and is commonly defined and exacerbated by its co‐morbid conditions. Neurohormonal imbalance and systemic inflammation are some of the key pathomechanisms of HF but also commonly encountered co‐morbidities such as arterial hypertension, diabetes mellitus, cachexia, obesity and sleep‐disordered breathing. A cornerstone of HF management is neurohormonal blockade, which in HF with reduced ejection fraction has been tied to a reduction in morbidity and mortality. Pharmacological treatment effective in patients with HF with reduced ejection fraction did not show substantial effects in HF with preserved ejection fraction. Here, we review novel device‐based therapies using neuromodulation of extra‐cardiac targets to treat cardiometabolic disease.
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Affiliation(s)
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University, Saarbrücken, Germany
| | | | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Rolf Wachter
- Clinic and Polyclinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
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8
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Mahfoud F, Azizi M, Ewen S, Pathak A, Ukena C, Blankestijn PJ, Böhm M, Burnier M, Chatellier G, Durand Zaleski I, Grassi G, Joner M, Kandzari DE, Kirtane A, Kjeldsen SE, Lobo MD, Lüscher TF, McEvoy JW, Parati G, Rossignol P, Ruilope L, Schlaich MP, Shahzad A, Sharif F, Sharp ASP, Sievert H, Volpe M, Weber MA, Schmieder RE, Tsioufis C, Wijns W. Proceedings from the 3rd European Clinical Consensus Conference for clinical trials in device-based hypertension therapies. Eur Heart J 2021; 41:1588-1599. [PMID: 32211888 PMCID: PMC7174031 DOI: 10.1093/eurheartj/ehaa121] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michel Azizi
- Université de Paris, INSERM CIC1418, F-75015 Paris, France.,APHP, Hôpital Européen Georges Pompidou, Hypertension Unit, F-75015 Paris, France.,F-CRIN INI-CRCT Network, Nancy, France
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Atul Pathak
- F-CRIN INI-CRCT Network, Nancy, France.,Department of Cardivascular Medicine, INSERM 1048, Princess Grace Hospital (CHPG), Avenue Pasteur, 98000 Monaco, Monaco
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Gilles Chatellier
- Université de Paris, INSERM CIC1418, F-75015 Paris, France.,APHP, Hôpital Européen Georges Pompidou, Clinical Trial Unit, F-75015 Paris, France
| | | | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Michael Joner
- Deutsches Herzzentrum München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich, Munich, Germany
| | | | - Ajay Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | | | - Melvin D Lobo
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, Zürich, Switzerland.,Royal Brompton and Harefield Hospital Trust, Imperial College London, London, UK
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca-Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Patrick Rossignol
- F-CRIN INI-CRCT Network, Nancy, France.,Université de Lorraine, Inserm, Centre d'Investigations cliniques-plurithématique 1433, Inserm U1116, Nancy, France.,CHRU Nancy, Nancy, France
| | - Luis Ruilope
- Institute of Research i+12 and CIBER CV, Hospital 12 de Octubre and Faculty of Sport Medicine, European University, Madrid, Spain
| | - Markus P Schlaich
- Dobney Hypertension Centre, The University of Western Australia-Royal Perth Hospital Campus, Perth, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Atif Shahzad
- National University of Ireland Galway, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Faisal Sharif
- National University of Ireland Galway, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK.,University California San Francisco UCSF, San Francisco, USA.,Yunnan Hospital Fuwai, Kunming, China
| | - Massimo Volpe
- Sapienza University of Rome-Sant'Andrea Hospital Rome and IRCCS Neuromed, Pozzilli, Italy
| | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital, Erlangen, Germany
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, National University of Ireland Galway, Galway, Ireland
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Abstract
In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology (MIT), Cambridge, MA (F.M.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, Australia (M.S.)
- Departments of Cardiology (M.S.), Royal Perth Hospital, Australia
- Nephrology (M.S.), Royal Perth Hospital, Australia
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.S.)
| | - Melvin D Lobo
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.D.L.)
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (M.D.L.)
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10
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Anees Boles EF, Herold S. Reversible hypertension associated with complete heart block in a 6-year-old boy. Ann Pediatr Cardiol 2020; 13:248-251. [PMID: 32863664 PMCID: PMC7437617 DOI: 10.4103/apc.apc_163_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/27/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
We herein report a case of a 6-year-old boy with hypertension and complete heart block with a unique outcome. The patient was treated with an epicardial pacemaker followed by complete and sustained resolution of his hypertension with no further need for the previously prescribed antihypertensive medication.
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Affiliation(s)
| | - Steven Herold
- Department of Pediatrics, Carilion Clinic, Roanoke, Virginia, USA
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11
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Varvarousis D, Kallistratos M, Poulimenos L, Triantafyllis A, Tsinivizov P, Giannakopoulos A, Kyfnidis K, Manolis A. Cardiac arrhythmias in arterial hypertension. J Clin Hypertens (Greenwich) 2020; 22:1371-1378. [DOI: 10.1111/jch.13989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
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13
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Abstract
PURPOSE OF REVIEW To give an overview on recent developments in permanent implant-based therapy of resistant hypertension. RECENT FINDINGS The American Heart Association (AHA) recently updated their guidelines to treat high blood pressure (BP). As elevated BP now is defined as a systolic BP above 120 mmHg, the prevalence of hypertension in the USA has increased from 32% (old definition of hypertension) to 46%. In the past years, device- and implant-mediated therapies have evolved and extensively studied in various patient populations. Despite an initial drawback in a randomized controlled trial (RCT) of bilateral carotid sinus stimulation (CSS), new and less invasive and unilateral systems for baroreflex activation therapy (BAT) with the BAROSTIM NEO® have been developed which show promising results in small non-randomized controlled (RCT) studies. Selective vagal nerve stimulation (VNS) has been successfully evaluated in rodents, but has not yet been tested in humans. A new endovascular approach to reshape the carotid sinus to lower BP (MobiusHD™) has been introduced (baroreflex amplification therapy) with favorable results in non-RCT trials. However, long-term results are not yet available for this treatment option. A specific subgroup of patients, those with indication for a 2-chamber cardiac pacemaker, may benefit from a new stimulation paradigm which reduces the AV latency and therefore limits the filling time of the left ventricle. The most invasive approach for resistant hypertension still is the neuromodulation by deep brain stimulation (DBS), which has been shown to significantly lower BP in single cases. Implant-mediated therapy remains a promising approach for the treatment of resistant hypertension. Due to their invasiveness, such treatment options must prove superiority over conventional therapies with regard to safety and efficacy before they can be generally offered to a wider patient population. Overall, BAROSTIM NEO® and MobiusHD™, for which large RCTs will soon be available, are likely to meet those criteria and may represent the first implant-mediated therapeutical options for hypertension, while the use of DBS probably will be reserved for individual cases. The utility of VNS awaits appropriate assessment.
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14
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Rationale and evidence for the development of a durable device-based cardiac neuromodulation therapy for hypertension. ACTA ACUST UNITED AC 2018; 12:381-391. [DOI: 10.1016/j.jash.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
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15
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Do DH, Shivkumar K. Programmable Hypertension Control: Another Possible Indication for Implanted Pacemakers. J Am Heart Assoc 2017; 6:JAHA.117.008053. [PMID: 29275376 PMCID: PMC5779065 DOI: 10.1161/jaha.117.008053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center & Electrophysiology Programs, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center & Electrophysiology Programs, David Geffen School of Medicine at UCLA, Los Angeles, CA
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