Baroreflex: ready for prime-time?

This editorial refers to ‘Autonomic cardiac control independently predicts incident hypertension and systolic blood pressure in a multi-ethnic population: the HELIUS study’, by T.A. Bouwmeester et al., https://doi.org/10.1093/eurjpc/zwaf011. Recent advancements in device therapies for hypertension have sparked renewed interest in the sympathetic nervous system and one of its key regulatory loops: the arterial baroreflex. A prime example is carotid baroreceptor modulation using stimulation or amplification, which has proved effective in reducing blood pressure (BP) in both animal models and humans.1 Before its consideration as a potential therapeutic target, the baroreflex was primarily studied for its pathophysiological role in various diseases, particularly hypertension. The arterial baroreflex is a crucial BP regulator, functioning through stretch receptors located mainly in the carotid arteries and aortic arch, which are activated by changes in transmural pressure. The effector mechanism triggers a rapid feedback response to BP fluctuations, modulating cardiac output through sympathetic and parasympathetic systems and influencing arterial tone through sympathetic activity. This ‘beat-to-beat’ reflex is primarily involved in short-term BP regulation, although it may also play a role in long-term BP control because of its crucial interaction with the kidney.2