Effects of baroreceptor activation therapy on dipping behavior in patients with refractory hypertension - A prospective study of nondipper patients

Non-dipping is defined as an inadequate night-time blood pressure reduction of less than < 10 %. This inadequate reduction as well as an increase in nocturnal blood pressure is associated with an increased cardiovascular risk. The baroreflex activation therapy (BAT) is an interventional, sympathicoinhibitory proce-dure that allows the programming of different time intervals in order to achieve a differen-tiated influence on daily blood pressure. The primary objective of the present study was to analyze if escalating of nighttime BAT programming over a period of three months might contribute to an improvement of dip-ping status. In addition, parameters of pulse wave velocity, changes in practice und outpa-tient 24-hour- blood pressure as well as the side effect profile of the therapy were record-ed. In the group of 23 included patients (mean age 66 ± 9 years, mean BMI 32 ± 6kg/m2, 12 (50 %) diabetes mellitus, 16 (67 %) hyperlipoproteinemia, 12 (50 %) chronic kidney disease, 3 (13 %) on renal replacement therapy) an improvement of the systolic dipping from 2 6 % to 68 % (p = 0.03) as well as an improvement of the dipping profile could be shown after three months of BAT nocturnal dose escalation. With regard to night pro-gramming settings, an increase in pulse width from 237 ± 161µs to 267 ± 170µs (p = < 0.03) could be achieved, while amplitude (p = 0.95) and frequency (p = 0.09) re-mained unchanged. Ambulatory 24-hour-blood pressure values remained unchanged after three months BAT escalation, as did the practice blood pressure, pulse wave velocity and the number of anti-hypertensive drugs. These data suggest that a differentiated programming of BAT may lead to an improvement in nocturnal dipping in patients with resistant hypertension, which may lead to beneficial cardiovascular effects beyond the overall blood pressure reduction. The present data could help to generate optimized programming protocols for the BAT to achieve a standardized programming procedure, an optimal effectiveness on the BP and especially on the dipping profile of the patients with resistant hypertension. Larger ran-domized, controlled trials are needed to investigate the effect of BAT on dipping and car-diovascular risk.2022-02-1