Long-Term Follow-Up of Baroreflex Activation Therapy in Resistant Hypertension
Another Piece of the Puzzle?
See related article, pp 836–843
Hypertension is one of the most prevalent chronic diseases worldwide and strongly associated with adverse cardiovascular outcome. Numerous highly effective pharmacological therapies are available to treat elevated blood pressure (BP), but a substantial percentage of patients remain uncontrolled. Various reasons have been identified, including physician inertia, inadequate dosing or suboptimal combinations of antihypertensive treatments, inadequate patient adherence to treatment, the use of interfering drugs, an undiagnosed secondary hypertension, or the presence of resistant hypertension.1 There is a mass of evidence indicating the profound involvement of the autonomic nervous system in the development and progression of hypertension,2 which has recently moved into the limelight of clinical research. Several device-based treatment approaches have been investigated, one of these is baroreflex activation therapy (BAT) using a dedicated pacemaker. However, despite the strong pathophysiological rationale, BAT has not conclusively demonstrated its value for treatment of hypertension, and its place in the therapeutic armamentarium remains debated.1
de Leeuw et al3 report in this issue of Hypertension the 6-year long-term safety and efficacy results of 3 BAT studies (n=383 patients included and n=48 after 6 years), namely the US Rheos Feasibility Trial4 (prospective, nonrandomized), the DEBuT-HT trial5 (Device Based Therapy in Hypertension Trial; prospective, nonrandomized), and the Rheos Pivotal Trial6 (randomized, sham controlled). All 3 trials used the first-generation Rheos system (CVRx, MN) which was implanted in patients with resistant hypertension. The data provide important information and indicate that BAT had …