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(Hypertension. 2007;50:825.)
© 2007 American Heart Association, Inc.

Hypertension Grand Rounds

Management of Uncontrollable Hypertension With a Carotid Sinus Stimulation Device

From the Division of Hypertension, Departments of Nephrology/Hypertension (M.G.M.) and Cardiovascular Surgery (J.S.), University of Berne, Berne, Switzerland; and the Medical Faculty of the Charité (F.C.L.), Experimental and Clinical Research Center, HELIOS Klinikum Berlin-Buch, Berlin, Germany.

Correspondence to Friedrich C. Luft, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany. E-mail luft@charite.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Hypertensive crisis is a serious condition that results in target-organ damage, such as stroke, heart attack, or renal failure, if left untreated.¹ Causes of acute increases in blood pressure in patients with primary essential hypertension include medication noncompliance and poorly controlled chronic hypertension. Treatment of a hypertensive crisis should be tailored to each individual based on the extent of target-organ injury and comorbid conditions. Prompt and rapid reduction of blood pressure under continuous surveillance is essential. We encountered a patient with target-organ damage and poor response to accepted antihypertensive regimens. Many terms are used to describe this degree of hypertension; the term "uncontrollable" will be used here. After an 8-drug regimen was not successful, we elected a radical, controversial, but novel therapy. Only long-term clinical trials, perhaps above-and-beyond the trial in which we currently participate, will be necessary to answer the hypothesis that a device-based treatment can triumph over tablets alone.

	The Patient

 
A 58-year-old woman with known primary hypertension for 40 years was referred to our clinic because of difficult-to-control "resistant or uncontrollable" hypertension. She did not have diabetes or known renal disease. However, she did have modest proteinuria at 500 mg/d. Her left ventricle wall thickness was moderately enlarged by echocardiography. Five or more different concomitantly prescribed medications failed to result in adequate blood pressure control. She had been diagnosed earlier with accelerated (malignant) hypertension on the basis of severe headaches, retinal hemorrhages, and macular edema. Secondary causes of hypertension were sought but not identified. Her medication consisted of furosemide, . . . [Full Text of this Article]

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