Key result
Baroreflex activation therapy modulates cardiovascular autonomic control but requires trials with hard clinical endpoints.
Why the study?
Sympathetic predominance is implicated in treatment-resistant hypertension and heart failure, making arterial baroreceptors potential therapeutic targets for modulation through electrical carotid sinus stimulation.
Does baroreflex activation therapy through electrical carotid sinus stimulation improve outcomes in patients with treatment-resistant arterial hypertension and heart failure?
Does baroreflex activation therapy through electrical carotid sinus stimulation improve outcomes in patients with treatment-resistant arterial hypertension and heart failure?
Baroreflex activation therapy is a promising device-based approach for modulating autonomic control in hypertension and heart failure, but requires further validation in controlled trials with hard clinical endpoints.
Baroreflex activation therapy should not yet change practice; leaves open hard-endpoint efficacy in resistant hypertension and heart failure.
An imbalance between cardiovascular parasympathetic and sympathetic activity towards sympathetic predominance has been implicated in the pathogenesis of treatment-resistant arterial hypertension and heart failure. Arterial baroreceptors control efferent cardiovascular autonomic activity and have, therefore, been recognized as potential treatment targets. Baroreflex activation therapy through electrical carotid sinus stimulation is a device-based approach to modulate cardiovascular autonomic activity. Electrical carotid sinus stimulation lowered blood pressure in various hypertensive animal models and improved cardiac remodeling and survival in preclinical models of heart failure. In human mechanistic profiling studies, electrical carotid sinus stimulation lowered blood pressure through sympathetic inhibition with substantial inter-individual variability. The first-generation device reduced blood pressure in controlled and uncontrolled clinical trials. Controlled clinical trials proving efficacy in blood pressure reduction in patients with hypertension do not exist for the currently available second-generation carotid sinus stimulator. Investigations in heart failure patients showed improved symptoms, quality of life, and natriuretic peptide biomarkers. Electrical carotid sinus stimulation is an interesting technology to modulate cardiovascular autonomic control. However, controlled trials with hard clinical endpoints are required.
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Jordan et al. (2024) conducted a review in Treatment-resistant arterial hypertension and heart failure. Baroreflex activation therapy through electrical carotid sinus stimulation was evaluated. Baroreflex activation therapy through electrical carotid sinus stimulation modulates cardiovascular autonomic control, but controlled trials with hard clinical endpoints are required.
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