Navaneethan Sankar D, Lohmeier Thomas E, Bisognano John D
Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Am Soc Hypertens. 2009 Jan-Feb;3(1):69-74. doi: 10.1016/j.jash.2008.09.001. Epub 2008 Dec 2.
Hypertension is a major public health problem in both developing and developed countries. Despite the increasing awareness of hypertension and its implications among patients and the treating physicians, the prevalence of resistant hypertension remains high and is expected to increase. Many patients fail to reach their target blood pressure (BP) despite the wide availability of several antihypertensive agents and the continued recommendation of dietary and lifestyle modifications. Stimulation of the carotid sinus results in lowering of BP by initiating the baroreflex and, in so doing, reducing sympathetic tone and increasing renal excretory function, in part, by exerting inhibitory effects on renin secretion. Recent evidence from experimental studies suggests that the baroreflex may be more important in the setting of chronic hypertension than originally believed. In early-phase clinical trials that did not include control arms, implantation of a baroreflex stimulator yielded a sustained decrease in BP. An ongoing larger clinical trial with appropriate control arms is further exploring the safety and efficacy of the device. This article describes the history and potential mechanisms of action of this device including its extensive preclinical development and movement to human clinical trials.
高血压在发展中国家和发达国家都是一个主要的公共卫生问题。尽管患者和治疗医生对高血压及其影响的认识不断提高，但顽固性高血压的患病率仍然很高，而且预计还会上升。尽管有多种抗高血压药物可供广泛使用，并且持续推荐进行饮食和生活方式调整，但许多患者仍未能达到其目标血压（BP）。刺激颈动脉窦会通过启动压力反射来降低血压，从而降低交感神经张力并增加肾脏排泄功能，部分是通过对肾素分泌产生抑制作用来实现的。来自实验研究的最新证据表明，压力反射在慢性高血压情况下可能比最初认为的更为重要。在早期没有设置对照臂的临床试验中，植入压力反射刺激器可使血压持续下降。一项正在进行的、设有适当对照臂的更大规模临床试验正在进一步探索该装置的安全性和有效性。本文介绍了该装置的历史和潜在作用机制，包括其广泛的临床前开发以及向人体临床试验的推进情况。
