Baroreflex activation therapy lowers arterial pressure without apparent stimulation of the carotid bodies.
Carotid baroreflex activation therapy produces a sustained fall in blood pressure in patients with resistant hypertension. Because the activation electrodes are implanted at the level of the carotid sinus, it is conceivable that the nearby located carotid body chemoreceptors are stimulated as well. Physiological stimulation of the carotid chemoreceptors not only stimulates respiration but also increases sympathetic activity, which may counteract the effects of baroreflex activation. The aim of this exploratory study is to investigate whether there is concomitant carotid chemoreflex activation during baroreflex activation therapy. Fifteen participants with the Rheos system were included in this single-center study. At arrival at the clinic, the device was switched off for 2 hours while patients were at rest. Subsequently, the device was switched on at 6 electric settings of high and low frequencies and amplitudes. Respiration and blood pressure measurements were performed during all device activation settings. Multilevel statistical models were adjusted for age, sex, body mass index, antihypertensive therapeutic index, sleep apnea, coronary artery disease, systolic blood pressure, and heart rate. There was no change in end-tidal carbon dioxide, partial pressure of carbon dioxide, breath duration, and breathing frequency during any of the electric settings with the device. Nevertheless, mean arterial pressure showed a highly significant decrease during electric activation (P<0.001). Carotid baroreflex activation therapy using the Rheos system did not stimulate respiration at several electric device activation energies, which suggests that there is no appreciable coactivation of carotid body chemoreceptors during device therapy.
From the Department of Internal Medicine (T.A., E.J.B.M.G., R.S., P.W.d.L., A.A.K.) and Department of Respiratory Medicine (C.P.M.v.d.G.), Maastricht University Medical Center, Maastricht, The Netherlands.
Teba
T
Alnima
From the Department of Internal Medicine (T.A., E.J.B.M.G., R.S., P.W.d.L., A.A.K.) and Department of Respiratory Medicine (C.P.M.v.d.G.), Maastricht University Medical Center, Maastricht, The Netherlands.
Emilie J B M
EJ
Goedhart
From the Department of Internal Medicine (T.A., E.J.B.M.G., R.S., P.W.d.L., A.A.K.) and Department of Respiratory Medicine (C.P.M.v.d.G.), Maastricht University Medical Center, Maastricht, The Netherlands.
Randy
R
Seelen
From the Department of Internal Medicine (T.A., E.J.B.M.G., R.S., P.W.d.L., A.A.K.) and Department of Respiratory Medicine (C.P.M.v.d.G.), Maastricht University Medical Center, Maastricht, The Netherlands.
Chris P M
CP
van der Grinten
From the Department of Internal Medicine (T.A., E.J.B.M.G., R.S., P.W.d.L., A.A.K.) and Department of Respiratory Medicine (C.P.M.v.d.G.), Maastricht University Medical Center, Maastricht, The Netherlands.
Peter W
PW
de Leeuw
From the Department of Internal Medicine (T.A., E.J.B.M.G., R.S., P.W.d.L., A.A.K.) and Department of Respiratory Medicine (C.P.M.v.d.G.), Maastricht University Medical Center, Maastricht, The Netherlands. aa.kroon@mumc.nl.
Abraham A
AA
Kroon
D000328:Adult; D000368:Aged; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods; D002344:Carotid Body / Q000503:physiopathology*; D016001:Confidence Intervals; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
baroreflex; carotid body; electric stimulation; pressoreceptors; respiration