title: Renal responses to long-term carotid baroreflex activation therapy in patients with drug-resistant hypertension.
abstract: Carotid baroreflex activation has been demonstrated to provide enduring reductions in arterial blood pressure. The aim of this study was to investigate the effect of long-term therapy on renal function. A total of 322 patients were enrolled in the Rheos Pivotal Trial. Group 1 consisted of 236 patients who started baroreflex activation therapy 1 month after device implantation, whereas in the 86 patients from group 2 the device was activated 6 months later. Serum creatinine and urine albumin/creatinine ratio were collected at screening (before device activation), and at months 6 and 12. Multilevel statistical analyses were adjusted for various covariables. Serum creatinine increased from 78 to 84 μmol/L, and glomerular filtration rate decreased from 92 to 87 mL/min per 1.73 m(2) in group 1 at month 6 (P<0.05). These values did not change any further after 12 months of therapy. Patients with highest glomerular filtration rate showed the greatest decrease in glomerular filtration. Group 2 showed the same trends as group 1 even before device activation at month 6. Systolic blood pressure reduction seemed to be significantly related to the change in glomerular filtration rate in both groups. Albumin/creatinine ratio did not change in both groups during follow-up. In conclusion, baroreflex activation therapy in hypertensive patients is associated with an initial mild decrease in glomerular filtration rate, which may be considered as a normal hemodynamic response to the drop in blood pressure. Long-term treatment does not result in further decrease in renal function, indicating baroreflex activation as a safe and effective therapy.
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
authors.forename: Teba
authors.initials: T
authors.lastname: Alnima
authors.forename: Peter W
authors.initials: PW
authors.lastname: de Leeuw
authors.forename: Frans E S
authors.initials: FE
authors.lastname: Tan
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017704:Baroreflex / Q000187:drug effects* / Q000502:physiology; D001794:Blood Pressure; D002339:Carotid Arteries / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine
keywords: albumin/creatinine ratio; carotid baroreflex activation; drug-resistant hypertension; glomerular filtration rate; renal function