Impact of baroreflex activation therapy on renal function--a pilot study.

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Hypertension Research

Background:

• Resistant hypertension and chronic kidney disease (CKD) share a link through sympathetic nervous system overdrive.
• Baroreflex activation therapy (BAT) is known to lower blood pressure in resistant hypertension.
• The impact of BAT on renal function in CKD patients with resistant hypertension remains uninvestigated.

Purpose of the Study:

• To assess the effect of sympathetic inhibition via BAT on renal function in patients with CKD and resistant hypertension.
• To evaluate changes in blood pressure, proteinuria, albuminuria, and markers of kidney function after BAT.

Main Methods:

• A prospective study involving 23 CKD patients with resistant hypertension treated with BAT.
• Renal function was assessed using creatinine, cystatin C, glomerular filtration rate (GFR), renin, aldosterone, sodium excretion, and urine marker proteins before and 6 months after BAT.
• A control group was included to account for center effects and regression to the mean.

Main Results:

• Mean office blood pressure decreased significantly (p < 0.01), and the number of antihypertensive medications reduced (p = 0.02).
• Proteinuria and albuminuria showed significant reductions (p = 0.01), with greater effects in advanced CKD stages.
• The CKD-EPI cystatin C equation for estimated GFR improved (p = 0.02), though creatinine and GFR showed impairment.

Conclusions:

• This trial suggests potential nephroprotective effects of BAT in CKD patients with resistant hypertension.
• BAT demonstrated reductions in blood pressure and proteinuria, alongside stabilization of estimated GFR.
• These findings highlight BAT as a promising therapeutic option for managing complex cardiovascular and renal conditions.