This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 54/3/530    most recent HYPERTENSIONAHA.109.134023v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Wustmann, K. Articles by Delacrétaz, E. PubMed PubMed Citation Articles by Wustmann, K. Articles by Delacrétaz, E. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Related Collections Clinical Studies Other Treatment

(Hypertension. 2009;54:530.)
© 2009 American Heart Association, Inc.

Original Articles

Effects of Chronic Baroreceptor Stimulation on the Autonomic Cardiovascular Regulation in Patients With Drug-Resistant Arterial Hypertension

Kerstin Wustmann; Jan P. Kucera; Ingrid Scheffers; Markus Mohaupt; Abraham A. Kroon; Peter W. de Leeuw; Jürg Schmidli; Yves Allemann; Etienne Delacrétaz

From the Departments of Cardiology and Cardiovascular Surgery (K.W., J.S., Y.A., E.D.) and Nephrology/Hypertension (M.M.), University Hospital Bern, Bern, Switzerland; Department of Physiology (J.P.K.), University of Bern, Bern, Switzerland; Department of Internal Medicine (I.S., A.A.K., P.W.d.L.), University Hospital Maastricht, Maastricht, the Netherlands.

Correspondence to Etienne Delacrétaz, FESC, Cardiology, University Hospital Bern, 3010 Bern, Switzerland. E-mail etienne.delacretaz{at}insel.ch

In patients with drug-resistant hypertension, chronic electric stimulation of the carotid baroreflex is an investigational therapy for blood pressure reduction. We hypothesized that changes in cardiac autonomic regulation can be demonstrated in response to chronic baroreceptor stimulation, and we analyzed the correlation with blood pressure changes. Twenty-one patients with drug-resistant hypertension were prospectively included in a substudy of the Device Based Therapy in Hypertension Trial. Heart rate variability and heart rate turbulence were analyzed using 24-hour ECG. Recordings were obtained 1 month after device implantation with the stimulator off and after 3 months of chronic electric stimulation (stimulator on). Chronic baroreceptor stimulation decreased office blood pressure from 185±31/109±24 mm Hg to 154±23/95±16 mm Hg (P<0.0001/P=0.002). Mean heart rate decreased from 81±11 to 76±10 beats per minute^–1 (P=0.001). Heart rate variability frequency-domain parameters assessed using fast Fourier transformation (FFT; ratio of low frequency:high frequency: 2.78 versus 2.24 for off versus on; P<0.001) were significantly changed during stimulation of the carotid baroreceptor, and heart rate turbulence onset was significantly decreased (turbulence onset: –0.002 versus –0.015 for off versus on; P=0.004). In conclusion, chronic baroreceptor stimulation causes sustained changes in heart rate variability and heart rate turbulence that are consistent with inhibition of sympathetic activity and increase of parasympathetic activity in patients with drug-resistant systemic hypertension; these changes correlate with blood pressure reduction. Whether the autonomic modulation has favorable cardiovascular effects beyond blood pressure control should be investigated in further studies.

Key Words: baroreflex • arterial hypertension • electric baroreflex stimulation • heart rate variability • heart rate turbulence • drug-resistant arterial hypertension • cardiac autonomic system

This article has been cited by other articles:

				G. Grassi Assessment of Sympathetic Cardiovascular Drive in Human Hypertension: Achievements and Perspectives Hypertension, October 1, 2009; 54(4): 690 - 697. [Abstract] [Full Text] [PDF]