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Published on: October 25, 2019
Novel approaches: targeting sympathetic outflow in the carotid sinus
Dagmara Hering1, Krzysztof Narkiewicz1
1Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.
Insights
Uncontrolled hypertension remains a major cause of cardiovascular disease. Device-based therapies, including renal denervation and baroreflex activation, show promise for managing resistant hypertension when medications fail.
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Uncontrolled hypertension significantly contributes to global cardiovascular disease (CVD) morbidity and mortality.
- Despite available treatments, only 50% of hypertensive patients achieve adequate blood pressure (BP) control.
- Factors like medication non-adherence and clinician inertia impede effective hypertension management, increasing CVD risk and healthcare burden.
Purpose of the Study:
- To review the current landscape of device-based therapies for hypertension management.
- To highlight the potential of neurohumoral activation as a therapeutic target.
- To explore alternative and adjunctive treatment options beyond traditional polypharmacy.
Main Methods:
- Review of existing clinical data and studies on device-based therapies for hypertension.
- Focus on therapies targeting neurohumoral activation and baroreflex pathways.
- Inclusion of renal denervation (RDN), baroreflex activation therapy (BAT), carotid body denervation (CBD), and other emerging device interventions.
Main Results:
- Established clinical experience exists for RDN and BAT in hypertension management.
- Other device-based approaches like CBD and central arteriovenous anastomosis are also under investigation.
- These therapies offer potential mechanisms to address the pathophysiology of elevated BP.
Conclusions:
- Device-based therapies represent a growing area for managing resistant hypertension.
- Further research is needed to define the optimal role of these devices as alternatives or adjuncts to pharmacotherapy.
- These innovative approaches may offer new hope for patients with difficult-to-control hypertension and reduce associated CVD risks.
Abstract:
Uncontrolled hypertension drives the global burden of increased cardiovascular disease (CVD) morbidity and mortality. Although high blood pressure (BP) is treatable and preventable, only half of the patients with hypertension undergoing treatment have their BP controlled. The failure of polypharmacy to attain adequate BP control may be due to a lack of physiological response, however, medication non-adherence and clinician inertia to increase treatment intensity are critical factors associated with poor hypertension management. The long-time medication titration, lifelong drug therapy, and often multi-drug treatment strategy are frustrating when the BP goal is not achieved, leading to increased CVD risk and a substantial burden on the healthcare system. Growing evidence indicates that neurohumoral activation is critical in initiating and maintaining elevated BP and its adverse consequences. Over the past decades, device-based therapies targeting the mechanisms underlying hypertension pathophysiology have been extensively studied. Among these, robust clinical experience for hypertension management exists for renal denervation (RDN) and baroreflex activation therapy (BAT), carotid body denervation (CBD), central arteriovenous anastomosis, and to a lesser extent, deep brain stimulation. Future studies are warranted to define the role of device-based approaches as an alternative or adjunctive treatment option to treat hypertension.
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