Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Baroreflex activation therapy in hypertension

Abstract

The sympathetic nervous system is an effective homeostatic mechanism for modulating hemodynamics in times of stress and illness. Unfortunately, in some patients, this mechanism escapes physiologic control and through various mechanisms leads to resistant hypertension. Antihypertensive drug therapy is successful only to a point, leaving a significant percentage of patients nationwide with blood pressure measurements above guidelines despite being treated with at least three agents at maximally tolerated doses, consistent with a diagnosis of resistant hypertension. Novel methods of modifying the activity of the sympathetic nervous system have been studied in animals, and this review discusses the data in support of one of the techniques at the forefront of non-pharmacologic blood pressure therapy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Calhoun DA, Jones D, Textor S, Goff D, Murphy T, Toto R et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51: 1403–1419.

    Article  CAS  Google Scholar 

  2. Egan B, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC . Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation 2011; 124: 1046–1058.

    Article  Google Scholar 

  3. Balabanov A, Rossi MA . Epilepsy surgery and vagal nerve stimulation: what all neurologists should know. Semin Neurol 2008; 28: 355–363.

    Article  Google Scholar 

  4. Thimmig RF, Smith MB, Sullivan JM . Lumbar sympathectomy in the treatment of arteriosclerotic peripheral vascular disease. Surg Clin North Am 1958; 38: 1081–1091.

    Article  CAS  Google Scholar 

  5. Smithwick RH . Surgical treatment of Hypertension. Am J Med 1948; 4: 744–759.

    Article  CAS  Google Scholar 

  6. Freyberg RH, Peet MM . The effect on the kidney of bilateral splanchnicectomy in patients with hypertension. J Clin Invest 1937; 16: 49–65.

    Article  CAS  Google Scholar 

  7. Isenberg EM, Peet MM . The influence of supradiaphragmatic splanchnicectomy on the heart in hypertension. Am Heart J 1948; 35: 567–583.

    Article  Google Scholar 

  8. Page IH, Heuer GJ . A surgical treatment of essential hypertension. J Clin Invest 1935; 14: 22–26.

    Article  CAS  Google Scholar 

  9. Allen EV . Sympathectomy for essential hypertension. Circulation 1952; 6: 131–140.

    Article  CAS  Google Scholar 

  10. Bisognano JD, Bakris G, Nadim MK, Sanchez L, Kroon AA, Schafer J et al. Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. JACC 2011; 58: 765–773.

    Article  Google Scholar 

  11. Furlan R, Diedrich A, Rimoldi A, Palazzolo L, Porta C, Diedrich L et al. Effects of unilateral and bilateral carotid baroreflex stimulation on cardiac and neural sympathetic discharge oscillatory patterns. Circulation 2003; 108: 717–723.

    Article  Google Scholar 

  12. Tafil-Klawe M, Raschke F, Hildebrandt G . Functional asymmetry in carotid sinus cardiac reflexes in humans. Eur J Appl Physiol Occup Physiol 1990; 60: 402–405.

    Article  CAS  Google Scholar 

  13. Williamson JW, Raven PB . Unilateral carotid-cardiac baroreflex responses in humans. Am J Physiol 1993; 265: H1033–H1037.

    CAS  PubMed  Google Scholar 

  14. Williamson JW, Muzi M, Ebert TJ . Unilateral carotid sinus stimulation and muscle sympathetic nerve activity in man. Med Sci Sports Exerc 1996; 28: 815–821.

    Article  CAS  Google Scholar 

  15. Lohmeier TE, Irwin ED, Rossing MA, Sedar DJ, Kieval RS . Prolonged activation of the baroreflex produces sustained hypotension. Hypertension 2004; 43: 306–311.

    Article  CAS  Google Scholar 

  16. Lohmeier TE, Dwyer TM, Hildebrandt DA, Irwin ED, Rossing MA, Sedar DJ et al. Influence of prolonged baroreflex activation on arterial pressure in angiotensin. Hypertension 2005; 46: 1194–1200.

    Article  CAS  Google Scholar 

  17. Scheffers IJM, Kroon AA, Schmidli J, Jordan J, Tordoir JJM, Mohaupt MG et al. Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study. JACC 2010; 56: 1254–1258.

    Article  Google Scholar 

  18. Bakris GL, Nadim MK, Haller H, Lovett EG, Schafer JE, Bisognano JD . Baroreflex activation therapy provides durable benefit in patients with resistant hypertension: results of long-term follow-up in the Rheos Pivotal Trial. J Am Soc Hypertens 2012; 6: 152–158.

    Article  Google Scholar 

  19. Hoppe UC, Mathias-Christoph B, Wachter R, Beige J, Rump LC, Kroon AA et al. Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial. J Am Soc Hypertens 2012; 6: 270–276.

    Article  Google Scholar 

  20. Sica D, Bisognano J, Nadim M, Sanchez L, Bakris G . Individualized programming demonstrates feasibility of unilateral approach to delivery of baroreflex activation therapy. J Clin Hypertens 2011; 13 (suppl 1): A10.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J D Bisognano.

Ethics declarations

Competing interests

John Gassler has received research support from CVRx. John Bisognano has received consultant fees and research support from CVRx.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gassler, J., Bisognano, J. Baroreflex activation therapy in hypertension. J Hum Hypertens 28, 469–474 (2014). https://doi.org/10.1038/jhh.2013.139

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.139

Keywords

This article is cited by

Search

Quick links