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Wiener Medizinische Wochenschrift (1946) Dec 2014Arterial baroreceptors are pressure sensors found in the carotid sinus near the bifurcation of the carotid artery and in the aortic arch. Carotid interventions, whether...
Arterial baroreceptors are pressure sensors found in the carotid sinus near the bifurcation of the carotid artery and in the aortic arch. Carotid interventions, whether endovascular or surgical, affect this complicated control system and the post-interventional blood pressure behavior. Comparisons between the intervention techniques, however, are challenging due to the varying measurement methods, duration of observation, and patient populations. The question as to which interventional method is preferable, if undisturbed regulation of blood pressure is concerned, still remains unanswered. The fact that blood pressure events (i.e., hemodynamic instability, hypertension, unstable blood pressure) frequently occur both immediately after intervention and in the long term, mandates a particularly careful cardiopulmonary and blood pressure monitoring. Direct and indirect measurements of baroreceptor sensitivity can be helpful in identifying high-risk patients, although the association to hard clinical endpoints is rarely documented for methodological reasons.
Topics: Baroreflex; Blood Pressure; Carotid Arteries; Carotid Sinus; Electrocardiography; Endarterectomy, Carotid; Endovascular Procedures; Hemodynamics; Homeostasis; Humans; Hypertension; Pressoreceptors; Risk Factors
PubMed: 25394988
DOI: 10.1007/s10354-014-0327-4 -
Trends in Cardiovascular Medicine Oct 2020Atrial fibrillation (AF) is a rapidly growing clinical problem in routine practice, both for cardiologists as well as general practitioners. Current therapies aimed at... (Review)
Review
Atrial fibrillation (AF) is a rapidly growing clinical problem in routine practice, both for cardiologists as well as general practitioners. Current therapies aimed at the management of AF include anti-arrhythmic drug therapy and catheter ablation. These therapies have a number of limitations and risks, and have disappointing long-term efficacy in maintaining sinus rhythm and improving hard clinical outcomes. Because of this, there is growing interest in pursuing alternative management strategies in patients with AF. This review seeks to highlight emerging AF therapies, with a specific focus on several modalities aimed at modulation of the autonomic nervous system. These therapies have shown promise in early pre-clinical and clinical trials, and represent exciting alternatives to standard AF treatment.
Topics: Animals; Atrial Fibrillation; Autonomic Nervous System; Baroreflex; Heart Atria; Heart Rate; Humans; Kidney; Magnetic Field Therapy; Pressoreceptors; Recovery of Function; Renal Artery; Sympathectomy; Treatment Outcome; Vagus Nerve Stimulation
PubMed: 31708408
DOI: 10.1016/j.tcm.2019.10.009 -
Neuroscience Bulletin Feb 2019Clinical trials and animal experimental studies have demonstrated an association of arterial baroreflex impairment with the prognosis and mortality of cardiovascular... (Review)
Review
Clinical trials and animal experimental studies have demonstrated an association of arterial baroreflex impairment with the prognosis and mortality of cardiovascular diseases and diabetes. As a primary part of the arterial baroreflex arc, the pressure sensitivity of arterial baroreceptors is blunted and involved in arterial baroreflex dysfunction in cardiovascular diseases and diabetes. Changes in the arterial vascular walls, mechanosensitive ion channels, and voltage-gated ion channels contribute to the attenuation of arterial baroreceptor sensitivity. Some endogenous substances (such as angiotensin II and superoxide anion) can modulate these morphological and functional alterations through intracellular signaling pathways in impaired arterial baroreceptors. Arterial baroreceptors can be considered as a potential therapeutic target to improve the prognosis of patients with cardiovascular diseases and diabetes.
Topics: Animals; Baroreflex; Blood Pressure; Cardiovascular Diseases; Diabetes Mellitus; Humans; Ion Channels; Pressoreceptors
PubMed: 30146675
DOI: 10.1007/s12264-018-0274-y -
Advances in Chronic Kidney Disease Nov 2014To identify patients at increased risk of cardiovascular (CV) outcomes, apparent treatment-resistant hypertension (aTRH) is defined as having a blood pressure above goal... (Review)
Review
To identify patients at increased risk of cardiovascular (CV) outcomes, apparent treatment-resistant hypertension (aTRH) is defined as having a blood pressure above goal despite the use of 3 or more antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. Recent epidemiologic studies in selected populations estimated the prevalence of aTRH as 10% to 15% among patients with hypertension and that aTRH is associated with elevated risk of CV and renal outcomes. Additionally, aTRH and CKD are associated. Although the pathogenesis of aTRH is multifactorial, the kidney is believed to play a significant role. Increased volume expansion, aldosterone concentration, mineralocorticoid receptor activity, arterial stiffness, and sympathetic nervous system activity are central to the pathogenesis of aTRH and are targets of therapies. Although diuretics form the basis of therapy in aTRH, pathophysiologic and clinical data suggest an important role for aldosterone antagonism. Interventional techniques, such as renal denervation and carotid baroreceptor activation, modulate the sympathetic nervous system and are currently in phase III trials for the treatment of aTRH. These technologies are as yet unproven and have not been investigated in relationship to CV outcomes or in patients with CKD.
Topics: Aldosterone; Antihypertensive Agents; Blood Volume; Cardio-Renal Syndrome; Coronary Vasospasm; Diuretics; Drug Resistance; Electric Stimulation Therapy; Humans; Hypertension; Pressoreceptors; Receptors, Mineralocorticoid; Renal Insufficiency, Chronic; Renin-Angiotensin System; Sympathectomy; Sympathetic Nervous System
PubMed: 25443574
DOI: 10.1053/j.ackd.2014.08.006 -
Reviews in Cardiovascular Medicine Sep 2018The search of alternative methods for improving clinical management and outcomes of individuals affected by resistant hypertension has become a true health priority. In... (Review)
Review
The search of alternative methods for improving clinical management and outcomes of individuals affected by resistant hypertension has become a true health priority. In this review, we aimed at providing a timely overview and evidence synthesis on baroreflex activation therapy (BAT) and endovascular baroreflex amplification (EBA), two device-based therapies which rely on the principle of lowering blood pressure by stimulating the carotid baroreflex to decrease the sympathetic and enhance the parasympathetic activity. In resistant forms of arterial hypertension, accruing evidence has confirmed the capacity of these techniques to improve blood pressure control and to reduce the amount of anti-hypertensive therapy at cost of few side effects. Future results from ongoing randomized sham-controlled trials are eagerly awaited to best define the efficacy, safety and durability of effects in the long term before such an invasive approach may be considered as a suitable option in daily clinical practice.
Topics: Animals; Antihypertensive Agents; Baroreflex; Blood Pressure; Drug Resistance; Electric Stimulation Therapy; Humans; Hypertension; Implantable Neurostimulators; Pressoreceptors; Treatment Outcome
PubMed: 31054557
DOI: 10.31083/j.rcm.2018.03.3185 -
Clinical and Experimental Rheumatology Oct 2022Systemic sclerosis (SSc) is an autoimmune disease characterised by diffuse vasculopathy and fibrosis of skin and visceral organs. Moreover, autonomic dysfunction is also...
OBJECTIVES
Systemic sclerosis (SSc) is an autoimmune disease characterised by diffuse vasculopathy and fibrosis of skin and visceral organs. Moreover, autonomic dysfunction is also suggested as an important step during the multifactorial SSc pathogenesis. Baroreceptors are responsible for maintaining blood pressure by means of autonomic system modulation. Considering that autonomic dysfunction and arteriosclerosis can both reduce baroreceptor sensitivity (BRS), in this cross-sectional study we investigated BRS in SSc patients.
METHODS
Twenty-one SSc patients (mean age 55±10 years, 18 females) and 147 age/sex-matched healthy controls were recruited for the study. BRS (ms/mmHg) was measured by a Finapres® Midi device (Finapres Medical Systems, Amsterdam, The Netherlands). Other parameters were measured: blood pressure, heart rate, heart rate variability triangular index (HRVI), intima-media thickness (IMT), carotid distensibility and pulse wave velocity (PWV).
RESULTS
BRS was significantly lower in SSc patients compared to controls (6.3±3.3 vs. 10.7±6.8 ms/mmHg; p=0.004). IMT was comparable between SSc and controls, whereas carotid distensibility was lower in SSc (20.1±7.6 vs. 26.6±13.3 KPa-1·10-3; p=0.02) and PWV higher in SSc (8.4±1.3 vs. 7.1±1.1 m/sec; p=0.01). Furthermore, HRVI was lower in SSc (4.5±2.1 vs. 7.5±2.8; p<0.001). BRS impairment was independent from age and carotid distensibility in SSc patients, suggesting that BRS dysfunction could be only partially a consequence of SSc vasculopathy.
CONCLUSIONS
BRS was reduced in SSc patients compared with healthy controls. This finding could represent a SSc-related alteration involving the autonomic system, besides being the mere consequence of sclerodermic vasculopathy.
Topics: Female; Humans; Middle Aged; Aged; Pressoreceptors; Pulse Wave Analysis; Carotid Intima-Media Thickness; Cross-Sectional Studies; Carotid Arteries; Scleroderma, Systemic; Vascular Diseases
PubMed: 35916301
DOI: 10.55563/clinexprheumatol/4j6028 -
Der Anaesthesist Sep 2015Baroreceptor stimulators are novel implantable devices that activate the carotid baroreceptor reflex. This results in a decrease in activity of the sympathetic nervous... (Review)
Review
Baroreceptor stimulators are novel implantable devices that activate the carotid baroreceptor reflex. This results in a decrease in activity of the sympathetic nervous system and inhibition of the renin-angiotensin-aldosterone system. In patients with drug-resistant hypertension, permanent electrical activation of the baroreceptor reflex results in blood pressure reduction and cardiac remodeling. For correct intraoperative electrode placement at the carotid bifurcation, the baroreceptor reflex needs to be activated several times. Many common anesthetic agents, such as inhalation anesthetics and propofol dampen or inhibit the baroreceptor reflex and complicate or even prevent successful placement. Therefore, a specific anesthesia and pharmacological management is necessary to ensure successful implantation of baroreceptor reflex stimulators.
Topics: Anesthesia; Baroreflex; Electric Stimulation Therapy; Electrodes, Implanted; Humans; Pressoreceptors; Prosthesis Implantation
PubMed: 26275386
DOI: 10.1007/s00101-015-0061-3 -
The Canadian Journal of Cardiology May 2020The sympathetic nervous system plays a pivotal role in the long-term regulation of arterial blood pressure through the ability of the central nervous system to integrate... (Review)
Review
The sympathetic nervous system plays a pivotal role in the long-term regulation of arterial blood pressure through the ability of the central nervous system to integrate neurohumoral signals and differentially regulate sympathetic neural input to specific end organs. Part 1 of this review will discuss neural mechanisms of salt-sensitive hypertension, obesity-induced hypertension, and the ability of prior experiences to sensitize autonomic networks. Part 2 of this review focuses on new therapeutic advances to treat resistant hypertension including renal denervation and carotid baroactivation. Both advances lower arterial blood pressure by reducing sympathetic outflow. We discuss potential mechanisms and areas of future investigation to target the sympathetic nervous system.
Topics: Animals; Autonomic Pathways; Baroreflex; Humans; Hypertension; Kidney; Obesity; Pressoreceptors; Sodium, Dietary; Sympathectomy; Sympathetic Nervous System
PubMed: 32389344
DOI: 10.1016/j.cjca.2020.03.003 -
Nature Reviews. Nephrology Jul 2018Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients... (Review)
Review
Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Patients with resistant hypertension are at high risk of complications, particularly cardiovascular events, and optimization of medical treatment remains the cornerstone of their management. Such optimization should be based on simple algorithms and include the use of aldosterone antagonists. The available data from clinical trials do not support the use of device-based approaches such as renal denervation, baroreflex activation therapy or arteriovenous anastomosis for the treatment of resistant hypertension in the majority of patients. Therefore, device treatment remains a last-resort for patients with truly resistant hypertension in the context of clinical research in highly skilled tertiary referral centres. Future research should focus on improving understanding of the intrinsic (physiological and psychological factors) and extrinsic (environmental stressors) mechanisms that contribute to a lack of response to blood-pressure-lowering drugs in adherent patients. The use of biomarkers to identify patients with early target organ damage and new technologies, such as renal nerve stimulation, to predict blood pressure responses to renal denervation could aid the selection of patients who might benefit from device therapies.
Topics: Amiloride; Animals; Antihypertensive Agents; Arteriovenous Shunt, Surgical; Baroreflex; Blood Pressure Determination; Carotid Arteries; Carotid Body; Coronary Vasospasm; Electric Stimulation Therapy; Epithelial Sodium Channel Blockers; Humans; Hypertension; Medication Adherence; Mineralocorticoid Receptor Antagonists; Pressoreceptors; Renal Artery; Spironolactone; Sympathectomy
PubMed: 29700488
DOI: 10.1038/s41581-018-0006-6 -
Histochemistry and Cell Biology Feb 2019
Topics: Capsid Proteins; Carotid Sinus; Cell Proliferation; Female; Granulosa Cells; Herpesviridae; Humans; Machine Learning; Mass Spectrometry; Microscopy, Electron, Transmission; Pressoreceptors
PubMed: 30613913
DOI: 10.1007/s00418-019-01769-5