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Neural Regulation of Blood Pressure

Neural Regulation of Blood Pressure

The neural regulation of blood pressure involves intricate interactions between the autonomic nervous system (ANS) and cardiovascular system, ensuring adequate perfusion of tissues. This regulation primarily occurs through baroreceptor and chemoreceptor reflexes, involving both short-term and long-term mechanisms.
Baroreceptor Reflex
Baroreceptors, located in the carotid sinuses and aortic arch, detect changes in blood pressure. When blood pressure rises, these stretch-sensitive receptors...

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Baroreflex activation therapy through electrical carotid sinus stimulation.

Jens Jordan¹, Jens Tank², Karsten Heusser²

¹Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Medical Faculty, University of Cologne, Cologne, Germany.

Autonomic Neuroscience : Basic & Clinical

|November 16, 2024

Summary

Baroreflex activation therapy using electrical carotid sinus stimulation shows promise for treating resistant hypertension and heart failure by modulating autonomic activity. Further controlled trials are needed to confirm its efficacy and clinical benefits.

Keywords:

Autonomic nervous system Baroreflex Baroreflex activation therapy Heart failure Hypertension Parasympathetic nervous system Sympathetic nervous system

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Area of Science:

Cardiovascular autonomic regulation
Hypertension and heart failure pathogenesis
Baroreflex modulation

Background:

Sympathetic overactivity contributes to resistant hypertension and heart failure.
Arterial baroreceptors are key regulators of autonomic activity and potential therapeutic targets.
Baroreflex activation therapy (BAT) aims to restore autonomic balance.

Purpose of the Study:

To evaluate the efficacy of electrical carotid sinus stimulation (ECSS) in modulating cardiovascular autonomic activity.
To assess the impact of ECSS on blood pressure, cardiac remodeling, and heart failure symptoms.
To review the current evidence and identify the need for further clinical trials.

Main Methods:

Device-based neuromodulation via electrical stimulation of the carotid sinus.
Preclinical studies in animal models of hypertension and heart failure.
Human mechanistic profiling studies and clinical trials in hypertensive and heart failure patients.

Main Results:

ECSS demonstrated blood pressure reduction in animal models and human studies, primarily via sympathetic inhibition.
Preclinical data showed improvements in cardiac remodeling and survival in heart failure models.
Heart failure patients experienced improved symptoms, quality of life, and biomarker profiles.

Conclusions:

Electrical carotid sinus stimulation is a viable technology for modulating cardiovascular autonomic control.
While promising, controlled clinical trials with hard endpoints are essential to establish efficacy for hypertension.
Further research is needed to validate the benefits of ECSS in heart failure management.