Bilateral or unilateral stimulation for baroreflex activation therapy.

Area of Science:

• Cardiology
• Medical Devices
• Hypertension Management

Background:

• Resistant hypertension poses a significant clinical challenge.
• Device-based baroreflex activation therapy (BAT) has shown promise in reducing blood pressure.
• Previous BAT required bilateral electrode implantation, a potential limitation.

Purpose of the Study:

• To investigate the efficacy of unilateral baroreflex activation therapy (BAT) compared to bilateral BAT.
• To determine if a less invasive unilateral approach can achieve comparable or superior blood pressure reduction.
• To identify the optimal stimulation side for unilateral BAT.

Main Methods:

• The study randomized treatment-resistant hypertensive patients to immediate or deferred BAT.
• Stimulation parameters were individually optimized for maximal baroreflex activation.
• Patients received either unilateral or bilateral electrode implantation based on initial response.

Main Results:

• Unilateral BAT resulted in significantly lower blood pressure and heart rate compared to bilateral BAT after 6 months.
• Right-sided stimulation demonstrated superior blood pressure reduction compared to left-sided or bilateral stimulation.
• A total of 215 patients received unilateral stimulation, while 80 received bilateral.

Conclusions:

• Unilateral baroreflex activation therapy (BAT) is effective in lowering blood pressure in resistant hypertension.
• Right-sided unilateral BAT offers a more profound blood pressure-lowering effect than bilateral or left-sided stimulation.
• Unilateral BAT presents a potentially more practical and effective approach for managing resistant hypertension.