title: Acute Response to Unilateral Unipolar Electrical Carotid Sinus Stimulation in Patients With Resistant Arterial Hypertension.
abstract: Bilateral bipolar electric carotid sinus stimulation acutely reduced muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in patients with resistant arterial hypertension but is no longer available. The second-generation device uses a smaller unilateral unipolar disk electrode to reduce invasiveness while saving battery life. We hypothesized that the second-generation device acutely lowers BP and MSNA in treatment-resistant hypertensive patients. Eighteen treatment-resistant hypertensive patients (9 women/9 men; 53±11 years; 33±5 kg/m(2)) on stable medications have been included in the study. We monitored finger and brachial BP, heart rate, and MSNA. Without stimulation, BP was 165±31/91±18 mm Hg, heart rate was 75±17 bpm, and MSNA was 48±14 bursts per minute. Acute stimulation with intensities producing side effects that were tolerable in the short term elicited interindividually variable changes in systolic BP (-16.9±15.0 mm Hg; range, 0.0 to -40.8 mm Hg; P=0.002), heart rate (-3.6±3.6 bpm; P=0.004), and MSNA (-2.0±5.8 bursts per minute; P=0.375). Stimulation intensities had to be lowered in 12 patients to avoid side effects at the expense of efficacy (systolic BP, -6.3±7.0 mm Hg; range, 2.8 to -14.5 mm Hg; P=0.028 and heart rate, -1.5±2.3 bpm; P=0.078; comparison against responses with side effects). Reductions in diastolic BP and MSNA (total activity) were correlated (r(2)=0.329; P=0.025). In our patient cohort, unilateral unipolar electric baroreflex stimulation acutely lowered BP. However, side effects may limit efficacy. The approach should be tested in a controlled comparative study.
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Karsten
authors.initials: K
authors.lastname: Heusser
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Jens
authors.initials: J
authors.lastname: Tank
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Julia
authors.initials: J
authors.lastname: Brinkmann
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Jan
authors.initials: J
authors.lastname: Menne
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Jessica
authors.initials: J
authors.lastname: Kaufeld
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Silvia
authors.initials: S
authors.lastname: Linnenweber-Held
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Joachim
authors.initials: J
authors.lastname: Beige
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Mathias
authors.initials: M
authors.lastname: Wilhelmi
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: André
authors.initials: A
authors.lastname: Diedrich
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.).
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.affiliation: From the Institute of Clinical Pharmacology (K.H., J.T., J.B., J.J.), Clinic for Nephrology (J.M., J.K., S.L.-H., H.H.), Division for Cardiothoracic, Transplantation- and Vascular Surgery (M.W.), Hannover Medical School, Hannover, Germany; Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany (J.B.); and Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN (A.D.). jordan.jens@mh-hannover.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Jordan
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology; D017704:Baroreflex / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D002346:Carotid Sinus / Q000294:innervation*; D004351:Drug Resistance; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014664:Vasodilation / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents
keywords: autonomic nervous system; baroreflex; carotid sinus; electrodes; heart rate; hypertension; pressoreceptors
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