Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy: Results of the 6-Year Open Follow-Up.
Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (P<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (P<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (P<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, but they do not require specific measures and resolve over time.After a follow-up of 6 years, baroreflex activation therapy maintains its efficacy for persistent reduction of office blood pressure in patients with resistant hypertension without major safety issues.
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.). p.deleeuw@maastrichtuniversity.nl.
Peter W
PW
de Leeuw
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
John D
JD
Bisognano
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
George L
GL
Bakris
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
Mitra K
MK
Nadim
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
Hermann
H
Haller
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
Abraham A
AA
Kroon
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D001795:Blood Pressure Determination; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011311:Pressoreceptors / Q000503:physiopathology; D016896:Treatment Outcome
D000959:Antihypertensive Agents
baroreflex; blood pressure; heart failure; hypertension; pressoreceptors