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Efficacy of electrical baroreflex activation is independent of peripheral chemoreceptor modulation

Heusser, K. and Thöne, A. and Lipp, A. and Menne, J. and Beige, J. and Reuter, H. and Hoffmann, F. and Halbach, M. and Eckert, S. and Wallbach, M. and Koziolek, M. and Haarmann, H. and Joyner, M. and Paton, J.F.R. and Diedrich, A. and Haller, H. and Jordan, J. and Tank, J. (2020) Efficacy of electrical baroreflex activation is independent of peripheral chemoreceptor modulation. Hypertension, 75 (1). American Heart Association, Inc.. DOI: 10.1161/HYPERTENSIONAHA.119.13925 ISSN 0194-911X (In Press)

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Abstract

Arterial baroreflex activation through electrical carotid sinus stimulation has been developed for the treatment of resistant hypertension. Previous studies suggested that the peripheral chemoreflex is tonically active in hypertensive patients and may inhibit baroreflex responses. We hypothesized that peripheral chemoreflex activation attenuates baroreflex efficacy evoked by electrical carotid sinus stimulation. We screened 35 patients with an implanted electrical carotid sinus stimulator. Of those, 11 patients with consistent acute depressor response were selected (7 men/4 women, age: 67±8 years, body mass index: 31.6±5.2 kg/m2, 6±2 antihypertensive drug classes). We assessed responses to electrical baroreflex stimulation during normoxia, isocapnic hypoxia (SpO2: 79.0±1.5%), and hyperoxia (40% end-tidal O2 fraction) by measuring heart rate, blood pressure, ventilation, oxygen saturation, end-tidal CO2 and O2 fractions, and muscle sympathetic nerve activity. During normoxia, baroreflex activation reduced systolic blood pressure from 164±27 to 151±25 mm Hg (mean±SD, P<0.001), heart rate from 64±13 to 61±13 bpm (P=0.002), and muscle sympathetic nerve activity from 42±12 to 36±12 bursts/min (P=0.004). Hypoxia increased systolic blood pressure 8±12 mm Hg (P=0.057), heart rate 10±6 bpm (P<0.001), muscle sympathetic nerve activity 7±7 bursts/min (P=0.031), and ventilation 10±7 L/min (P=0.002). However, responses to electrical carotid sinus stimulation did not differ between hypoxic and hyperoxic conditions: systolic blood pressure: -15±7 versus -14±8 mm Hg (P=0.938), heart rate: -2±3 versus -2±2 bpm (P=0.701), and muscle sympathetic nerve activity: -6±4 versus -4±3 bursts/min (P=0.531). We conclude that moderate peripheral chemoreflex activation does not attenuate acute responses to electrical baroreflex activation therapy in patients with resistant hypertension. These patients provided insight into human baroreflex-chemoreflex interactions that could not be gained otherwise.

Item URL in elib:https://elib.dlr.de/133069/
Document Type:Article
Title:Efficacy of electrical baroreflex activation is independent of peripheral chemoreceptor modulation
Authors:
AuthorsInstitution or Email of AuthorsAuthors ORCID iD
Heusser, K.Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.UNSPECIFIED
Thöne, A.Clinical Research Center, Hannover Medical School, Hannover, GermanyUNSPECIFIED
Lipp, A.Department of Neurology, Charité University-Medicine Berlin, Berlin, GermanyUNSPECIFIED
Menne, J.Department of Nephrology and Hypertension, Hannover Medical School, Hannover, GermanyUNSPECIFIED
Beige, J.Department of Nephrology and KfH Renal Unit, Hospital St. Georg Leipzig, Leipzig, GermanyUNSPECIFIED
Reuter, H.Department of Internal Medicine and Cardiology, Evangelisches Klinikum Köln Weyertal, CologneUNSPECIFIED
Hoffmann, F.Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.;Department of Cardiology, Pneumology, and Angiology, Heart Center of the University of Cologne, GermanyUNSPECIFIED
Halbach, M.Department of Cardiology, Pneumology, and Angiology, Heart Center of the University of Cologne, Cologne, GermanyUNSPECIFIED
Eckert, S.Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Bad Oeynhausen, GermanyUNSPECIFIED
Wallbach, M.Department of Nephrology & Rheumatology, University Medical Center Göttingen, Göttingen, GermanyUNSPECIFIED
Koziolek, M.Department of Nephrology & Rheumatology, University Medical Center Göttingen, Göttingen, GermanyUNSPECIFIED
Haarmann, H.Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, GermanyUNSPECIFIED
Joyner, M.Department of Anesthesiology, Mayo Clinic, Rochester, Rochester, MNUNSPECIFIED
Paton, J.F.R.School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United KingdomUNSPECIFIED
Diedrich, A.Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TNUNSPECIFIED
Haller, H.Department of Nephrology and Hypertension, Hannover Medical School, Hannover, GermanyUNSPECIFIED
Jordan, J.Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Jens.Jordan (at) dlr.dehttps://orcid.org/0000-0003-4518-0706
Tank, J.German Aerospace Center, Institute of Aerospace Medicinehttps://orcid.org/0000-0002-5672-1187
Date:January 2020
Journal or Publication Title:Hypertension
Refereed publication:Yes
Open Access:No
Gold Open Access:No
In SCOPUS:Yes
In ISI Web of Science:Yes
Volume:75
DOI :10.1161/HYPERTENSIONAHA.119.13925
Publisher:American Heart Association, Inc.
ISSN:0194-911X
Status:In Press
Keywords:baroreflex; blood pressure; carotid sinus; hyperoxia; hypoxia
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Forschung unter Weltraumbedingungen
DLR - Research theme (Project):R - Vorhaben Systemphysiologie
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Institute of Aerospace Medicine > Cardiovascular Medicine in Aerospace
Institute of Aerospace Medicine > Leitungsbereich ME
Deposited By: Schrage, Larissa
Deposited On:07 Jan 2020 12:16
Last Modified:09 Jan 2020 12:24

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