Baroreflex Activation Therapy — EECC MCQ
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Correct answer: C — Baroreflex activation therapy (BAT) — electrical stimulation of the carotid baroreceptors increases parasympathetic and decreases sympathetic outflow, reducing BP; the Rheos and Barostim neo trials showed significant BP reduction in resistant HTN, though adoption is limited by device cost and invasiveness
Device-based therapies for resistant hypertension are evolving: (1) Renal denervation: catheter-based ablation of renal sympathetic nerves (SPYRAL, RADIANCE trials — ~5-10 mmHg SBP reduction, Class IIb); (2) Baroreflex activation therapy (BAT): surgically implanted device electrically stimulates the carotid sinus baroreceptors, triggering the baroreflex arc → increased parasympathetic output, decreased sympathetic output → BP reduction. Rheos system (bilateral carotid stimulation) → Barostim neo (unilateral, simpler). Clinical evidence: significant BP reductions (20-30 mmHg SBP in some studies), but limited by: device cost, surgical implantation, battery life, and limited long-term data; (3) Arteriovenous anastomosis (ROX coupler): creates a controlled iliac AV fistula to reduce peripheral resistance — promising early results but limited adoption. The 2024 ESC HTN Guidelines position these as investigational/limited-availability options for truly refractory hypertension.
Reference: ESC (2024): Hypertension Guidelines