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

BACKGROUND: 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). METHODS:...

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Autores principales: van Kleef, Monique E. A. M., Heusser, Karsten, Diedrich, André, Oey, P. Liam, Tank, Jens, Jordan, Jens, Blankestijn, Peter J., Williams, Bryan, Spiering, Wilko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594823/
https://www.ncbi.nlm.nih.gov/pubmed/34784359
http://dx.doi.org/10.1371/journal.pone.0259826
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author van Kleef, Monique E. A. M.
Heusser, Karsten
Diedrich, André
Oey, P. Liam
Tank, Jens
Jordan, Jens
Blankestijn, Peter J.
Williams, Bryan
Spiering, Wilko
author_facet van Kleef, Monique E. A. M.
Heusser, Karsten
Diedrich, André
Oey, P. Liam
Tank, Jens
Jordan, Jens
Blankestijn, Peter J.
Williams, Bryan
Spiering, Wilko
author_sort van Kleef, Monique E. A. M.
collection PubMed
description BACKGROUND: 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). METHODS: 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). RESULTS: 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 msec(2), 78 to 1168). In contrast, BRS and cardiovascular responses remained unchanged after EVBA. CONCLUSIONS: In this proof-of-principle study, EVBA did not significantly decrease MSNA in patients with resistant hypertension. EVBA did not impair baroreflex function. TRIAL REGISTRATION: Clinical trial registration at NCT02827032.
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spelling pubmed-85948232021-11-17 Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study van Kleef, Monique E. A. M. Heusser, Karsten Diedrich, André Oey, P. Liam Tank, Jens Jordan, Jens Blankestijn, Peter J. Williams, Bryan Spiering, Wilko PLoS One Research Article BACKGROUND: 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). METHODS: 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). RESULTS: 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 msec(2), 78 to 1168). In contrast, BRS and cardiovascular responses remained unchanged after EVBA. CONCLUSIONS: In this proof-of-principle study, EVBA did not significantly decrease MSNA in patients with resistant hypertension. EVBA did not impair baroreflex function. TRIAL REGISTRATION: Clinical trial registration at NCT02827032. Public Library of Science 2021-11-16 /pmc/articles/PMC8594823/ /pubmed/34784359 http://dx.doi.org/10.1371/journal.pone.0259826 Text en © 2021 van Kleef et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
van Kleef, Monique E. A. M.
Heusser, Karsten
Diedrich, André
Oey, P. Liam
Tank, Jens
Jordan, Jens
Blankestijn, Peter J.
Williams, Bryan
Spiering, Wilko
Endovascular baroreflex amplification and the effect on sympathetic nerve activity in patients with resistant hypertension: A proof-of-principle study
title 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_short 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594823/
https://www.ncbi.nlm.nih.gov/pubmed/34784359
http://dx.doi.org/10.1371/journal.pone.0259826
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