Efficacy of carotid devices for resistant hypertension: a systematic review

Background Resistant hypertension (RHT) affects 10–30% of hypertensive patients, posing a significant challenge, as it leads to greater cardiovascular comorbidities and mortality. Baroreceptor-based therapies, targeting the autonomic nervous system, represent a novel approach for managing RHT when conventional treatments fail. Objective To evaluate the efficacy, safety, and future potential of carotid devices, including Rheos, Barostim Neo, and MobiusHD, in reducing blood pressure (BP) in patients with RHT. Methods A PRISMA-guided search of PubMed/Medline, Scopus, and Cochrane databases was conducted to identify studies on carotid baroreceptor devices up to August 2024. Studies were screened for original data on device efficacy and safety, excluding case reports, abstracts, and non-English publications. Data on study design, patient characteristics, and outcomes were extracted and analyzed. Results Sixteen studies covering Rheos (n=8), Barostim Neo (n=5), and MobiusHD (n=3) were included. Rheos demonstrated significant BP reductions in phase II and III trials but was associated with procedural complications due to its bilateral design. Barostim Neo, a second-generation device, showed comparable efficacy, with a lower complication rate and better compatibility with cardiac devices. MobiusHD, a mechanical endovascular implant, significantly reduced BP over 3 years of follow-up but exhibited procedural risks, such as transient ischemic attacks. Conclusion Carotid devices offer a promising solution for managing RHT, with Barostim Neo emerging as a safer alternative than Rheos. While MobiusHD demonstrates efficacy, further trials are needed to confirm its safety. Additional studies with standardized trial designs and long-term follow-ups will enhance our understanding of the role of carotid-based therapies in hypertension management.