Baroreflex activation therapy systems: current status and future prospects

Introduction: Resistant hypertension is characterized by an hyperadrenergic tone and by a neurohumoral activation. In this condition drug therapies are unable to obtain a good control of blood pressure and therefore need a contribution from non-pharmachological approach. To this aim it has been hypothesized that to lower blood pressure this could be obtained through stimulation of carotid baroreceptors and modulation of the adrenergic tone. Areas covered: several studies and trials have evaluated the safety and efficacy of two devices-based therapies and this review will discuss the research obtained mainly in resistant hypertensive subjects. Expert opinion: the studies performed have clearly shown the safety and efficacy of these approaches. The stimulation of carotid baroreceptors induces a significant reduction in blood pressure values associated with a reduction in adrenergic tone. The two systems have same limitations. While baroreflex activation therapy has been upgraded to a more simple system, an upgrade of endovascular baroreflex amplification will be able to reduce the side effects. Due to the fact that neurohumoral activation and hyperadrenergic tone are present in several pathophysiological conditions it is possible to assume a wider use of these systems in the future.