Carotid baroreceptor activation therapy for resistant hypertension and heart failure: a report of two cases

Introduction

A vast number of drugs and treatment strategies have been approved for treatment of hypertension in the last three decades. However, despite these advances, there is still a reported prevalence of 3 to 30% of treatment-resistant hypertension (TRH) [1]. According to 2013 ESH/ESC guidelines for the management of arterial hypertension, TRH is defined as an office measurement of systolic blood pressure (BP) > 140 mm Hg and/or diastolic BP of > 90 mm Hg despite appropriate life-style measures and antihypertensive treatment including a diuretic (at full dose) and two other antihypertensive drugs of different classes at adequate doses [2]. Following catheter-based renal denervation therapy, the concept of TRH has gained popularity and specific therapies have emerged including carotid baroreceptor activation therapy (BAT).
Similar to the concept of TRH, despite enormous advances in surgical and medical treatment of heart failure (HF), 25 to 35% of cases remain in NYHA class III. These patients often experience moderate to severe heart failure symptoms and have a low quality of life, causing increased health care costs. We already know that adrenergic activation and parasympathetic denervation have a role in symptom occurrence and disease progression [3]. With this rationale, carotid BAT has emerged as a therapeutic strategy in treatment of heart failure.
Here, we report two cases, one with resistant hypertension and the other with heart failure treated with surgical BAT.
Written informed consent was obtained from each patient for submission of the report.

Case reports

Case 1

A 52-year-old male patient was being followed up for hypertension for 10 years and TRH was diagnosed one year ago. He had coronary artery disease and type 2 diabetes mellitus. He had a triple vessel bypass 10 years ago and repeat percutaneous coronary intervention (PCI) was performed for left anterior descending artery (LAD) and right coronary arteries in the following years. He was on a b-blocker and angiotensin receptor antagonist/diuretic combination. His ambulatory blood pressure monitoring (ABPM) record (Ambulatory Blood Pressure Monitor, Model: ABPM50, Contec Medical Systems Co., Ltd, People’s Republic of China) revealed a mean systolic BP of 155 mm Hg and diastolic BP of 100 mm Hg despite therapy. He was scheduled for carotid baroreflex activation therapy (BAT) and surgical insertion was performed successfully. A mean...


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