title: Carotid baroreflex activation therapy for resistant hypertension.
abstract: Arterial baroreceptors are mechanosensitive sensory nerve endings in the walls of the carotid sinuses and aortic arch that buffer the increases and decreases in arterial blood pressure. Electrical field stimulation of the carotid sinus, known as carotid baroreflex activation therapy, holds promise as a novel device-based intervention to supplement, but not replace, drug therapy for patients with resistant hypertension. Acute electrical field stimulation of even one carotid sinus can cause a sufficiently large reflex decrease in blood pressure to overcome offsetting reflexes from the contralateral carotid baroreceptors and aortic baroreceptors that are not paced. However, the initial phase III Rheos Pivotal Trial on continuous carotid baroreceptor pacing for resistant hypertension with the first-generation baroreceptor pacemaker yielded equivocal data on efficacy and adverse effects due to facial nerve injury during surgical implantation. A miniaturized second-generation pacing electrode has seemingly overcome the safety issue, and early results with the new device suggest efficacy of unilateral carotid sinus stimulation in heart failure. A phase III trial of this new device for resistant hypertension has been registered.
authors.affiliation: The Cedars-Sinai Hypertension Centre, The Heart Institute, Cedars-Sinai Medical Centre, 127 South San Vicente Boulevard, Suite A9111, Los Angeles, CA 90048, USA.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Victor
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D017704:Baroreflex / Q000502:physiology*; D002339:Carotid Arteries / Q000502:physiology; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use; D004351:Drug Resistance; D004525:Efferent Pathways / Q000502:physiology; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D004566:Electrodes; D004867:Equipment Design; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000294:innervation; D013564:Sympathetic Nervous System / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics