Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study

<h4>Background</h4> First in human studies suggest that endovascular baroreflex amplification (EVBA) lowers blood pressure (BP). To explore potential mechanisms for BP reduction, this study examines the effects of EVBA on muscle sympathetic nerve activity (MSNA) and baroreceptor sensitiv...

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Autores principales:	Monique E. A. M. van Kleef, Karsten Heusser, André Diedrich, P. Liam Oey, Jens Tank, Jens Jordan, Peter J. Blankestijn, Bryan Williams, Wilko Spiering
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/edeed791535346549be1283a97076f5f
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spelling	oai:doaj.org-article:edeed791535346549be1283a97076f5f2021-11-25T06:10:51ZEndovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study1932-6203https://doaj.org/article/edeed791535346549be1283a97076f5f2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594823/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> First in human studies suggest that endovascular baroreflex amplification (EVBA) lowers blood pressure (BP). To explore potential mechanisms for BP reduction, this study examines the effects of EVBA on muscle sympathetic nerve activity (MSNA) and baroreceptor sensitivity (BRS). <h4>Methods</h4> In a single-center sub-study of the CALM-DIEM study (Controlling And Lowering blood pressure with the MobiusHD—Defining Efficacy Markers), 14 patients with resistant hypertension were treated with EVBA. Microneurography and non-invasive continuous BP measurements were performed at baseline and three months after MobiusHD implantation. The primary outcome was change in MSNA. Secondary outcomes were change in baroreflex sensitivity (BRS), cardiovascular responses to a sympathetic stimulus, BP, heart rate (HR) and heart rate variability (HRV). <h4>Results</h4> The primary endpoint was obtained in 10 of 14 patients enrolled in the sub-study. MSNA burst frequency and burst incidence decreased in 6 of 10 patients: mean change -4.1 bursts/min (95% confidence interval -12.2 to 4.0) and -3.8 bursts/100 heartbeats (-15.2 to 7.7). MSNA spike frequency and spike count decreased in 8 of 10 patients: mean change -2.8 spikes/sec (-7.3 to 1.8) and -3.0 spikes/heartbeat (-6.1 to 0.1). Change in MSNA and BP were not correlated. Office BP decreased by -14/-6 mmHg (-27 to -2/-15 to 3). We observed a trend towards decreased HR (-5 bpm, -10 to 1) and increased total power HRV (623 msec2, 78 to 1168). In contrast, BRS and cardiovascular responses remained unchanged after EVBA. <h4>Conclusions</h4> In this proof-of-principle study, EVBA did not significantly decrease MSNA in patients with resistant hypertension. EVBA did not impair baroreflex function. <h4>Trial registration</h4> Clinical trial registration at NCT02827032.Monique E. A. M. van KleefKarsten HeusserAndré DiedrichP. Liam OeyJens TankJens JordanPeter J. BlankestijnBryan WilliamsWilko SpieringPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Monique E. A. M. van Kleef Karsten Heusser André Diedrich P. Liam Oey Jens Tank Jens Jordan Peter J. Blankestijn Bryan Williams Wilko Spiering Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
description	<h4>Background</h4> First in human studies suggest that endovascular baroreflex amplification (EVBA) lowers blood pressure (BP). To explore potential mechanisms for BP reduction, this study examines the effects of EVBA on muscle sympathetic nerve activity (MSNA) and baroreceptor sensitivity (BRS). <h4>Methods</h4> In a single-center sub-study of the CALM-DIEM study (Controlling And Lowering blood pressure with the MobiusHD—Defining Efficacy Markers), 14 patients with resistant hypertension were treated with EVBA. Microneurography and non-invasive continuous BP measurements were performed at baseline and three months after MobiusHD implantation. The primary outcome was change in MSNA. Secondary outcomes were change in baroreflex sensitivity (BRS), cardiovascular responses to a sympathetic stimulus, BP, heart rate (HR) and heart rate variability (HRV). <h4>Results</h4> The primary endpoint was obtained in 10 of 14 patients enrolled in the sub-study. MSNA burst frequency and burst incidence decreased in 6 of 10 patients: mean change -4.1 bursts/min (95% confidence interval -12.2 to 4.0) and -3.8 bursts/100 heartbeats (-15.2 to 7.7). MSNA spike frequency and spike count decreased in 8 of 10 patients: mean change -2.8 spikes/sec (-7.3 to 1.8) and -3.0 spikes/heartbeat (-6.1 to 0.1). Change in MSNA and BP were not correlated. Office BP decreased by -14/-6 mmHg (-27 to -2/-15 to 3). We observed a trend towards decreased HR (-5 bpm, -10 to 1) and increased total power HRV (623 msec2, 78 to 1168). In contrast, BRS and cardiovascular responses remained unchanged after EVBA. <h4>Conclusions</h4> In this proof-of-principle study, EVBA did not significantly decrease MSNA in patients with resistant hypertension. EVBA did not impair baroreflex function. <h4>Trial registration</h4> Clinical trial registration at NCT02827032.
format	article
author	Monique E. A. M. van Kleef Karsten Heusser André Diedrich P. Liam Oey Jens Tank Jens Jordan Peter J. Blankestijn Bryan Williams Wilko Spiering
author_facet	Monique E. A. M. van Kleef Karsten Heusser André Diedrich P. Liam Oey Jens Tank Jens Jordan Peter J. Blankestijn Bryan Williams Wilko Spiering
author_sort	Monique E. A. M. van Kleef
title	Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
title_short	Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
title_full	Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
title_fullStr	Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
title_full_unstemmed	Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
title_sort	endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: a proof-of-principle study
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/edeed791535346549be1283a97076f5f
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Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study

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