Baroreflex activation therapy for resistant hypertension

This study looked at the effectiveness and safety of different baroreflex activation therapy (BAT) devices for resistant hypertension. The authors concluded that BAT devices are effective at reducing blood pressure and maintaining this reduction in patients with resistant hypertension.

Patients with hypertension have a higher resting blood pressure than the body needs. The blood pressure needs to be lowered to avoid cardiovascular complications such as heart attacks, strokes, and heart failure. Resistant hypertension, where blood pressure is consistently higher than 140/90 mm Hg, usually requires treatment with three or more drugs.

Intense drug treatment is not always effective or can cause unwanted side effects. As a result, treatments other than drug therapy for resistant hypertension are being investigated. Baroreflex activation therapy (BAT) is a procedure where a small device is implanted under the patient’s skin. This device delivers a small electrical pulse to the carotid arteries (the veins that supply blood to the brain). This may reduce arterial stiffness and central blood pressure which are risk factors for cardiovascular disease. The stiffness of arteries influences how hard the heart has to work to pump blood through the body. 

The Rheos Baroreflex Hypertension Therapy Device is a type of BAT device that is associated with good effectiveness in reducing blood pressure in patients with hypertension. However, invasive surgery is needed to implant the generator and leads. The Barostim neo device has recently been developed as a less invasive alternative.

One Rheos BAT device trial included 45 patients with resistant hypertension. The average systolic blood pressure (SBP – pressure when the heart is contracting) was reduced by 21 mm Hg at 3 months. SBP was reduced by 30 mm Hg at 1 year and by 33 mm Hg at 2 years. The average diastolic blood pressure (DBP – pressure when the heart is between beats) was reduced by 12 mm Hg at 3 months, by 20 mm Hg at 1 year, and by 22 mm Hg at 2 years.

In another Rheos BAT device trial, 54% of patients using the device showed more than a 10 point drop in SBP at 6 months compared to 46% of the control group. Patients maintained these improvements for up to 5 years. Some instances of stroke and heart attack were recorded, but the risk was very low and considered acceptable for the benefits.

A Barostim neo trial included 30 patients with resistant hypertension. The average reduction in SBP was 26.1 mm Hg at 3 months and was maintained at a 6 moth follow-up. 43% of patients reached the goal SBP of less than 140 mm Hg after 6 months of treatment. Larger trials are needed to confirm these early results.

The authors concluded that BAT devices are safe and effective in reducing blood pressure for patients with resistant hypertension.

Consult with your physician to discuss possible non-drug treatment options for resistant hypertension.