Neuromodulation therapies demonstrated improvements in autonomic modulation, functional gains, and blood pressure control as adjunctive treatments for heart failure and resistant hypertension.
Do neuromodulation therapies improve clinical, hemodynamic, or autonomic outcomes in adults with heart failure or resistant hypertension?
Neuromodulation therapies show relevant clinical potential as adjunctive treatments to conventional pharmacological therapy for heart failure and resistant hypertension, though robust long-term clinical trials are needed.
Heart failure and resistant hypertension are major clinical challenges frequently associated with autonomic nervous system dysfunction and sustained sympathetic hyperactivity. In this context, neuromodulation therapies have emerged as innovative strategies aimed at restoring autonomic balance and improving cardiovascular outcomes. To critically analyze recent scientific evidence on new neuromodulation therapies applied to heart failure and resistant hypertension, emphasizing physiological mechanisms, clinical outcomes, and future perspectives for clinical practice. An integrative literature review was conducted in PubMed, JACC, SciELO, and the American College of Cardiology databases using descriptors related to vagal stimulation, baroreflex activation, and renal denervation. Studies published within the last ten years with a minimum follow-up of six months were included. The main strategies identified were vagus nerve stimulation, carotid baroreflex activation therapy, and renal denervation. The analyzed studies demonstrated improvements in autonomic modulation, reductions in sympathetic activity, functional gains, and, in selected trials, increases in left ventricular ejection fraction and blood pressure control. Neuromodulation therapies show relevant clinical potential as adjunctive treatments to conventional pharmacological therapy, particularly in refractory patients. However, methodological heterogeneity and limited long-term data highlight the need for robust clinical trials to support their routine clinical adoption.
Vieira et al. (Fri,) conducted a review in Heart failure and resistant hypertension. Neuromodulation therapies (vagus nerve stimulation, baroreflex activation, renal denervation) vs. Conventional pharmacological therapy or placebo was evaluated on Clinical, hemodynamic, or autonomic outcomes. Neuromodulation therapies demonstrated improvements in autonomic modulation, functional gains, and blood pressure control as adjunctive treatments for heart failure and resistant hypertension.