Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial

Krzysztof Narkiewicz, Laura Ratcliffe, Emma Hart, Linford Briant, Marzena Chrostowska, Jacek Wolf, Anna Szyndler, Dagmara Hering, Ana Abdala Abdala Sheikh, Nathan E. Manghat, Amy Burchell, Claire Durant, Melvin D Lobos, Paul A Sobotka, Nik Patel, James C Leiter, Zoar J Engelman, Angus Nightingale, Julian Paton

Research output: Contribution to journalArticle (Academic Journal)peer-review

61 Citations (Scopus)
273 Downloads (Pure)

Abstract

Objectives

Perform a proof of concept study to test the safety and feasibility of unilateral carotid body resection in patients with drug resistant hypertension, and assess what proportion of the patients showed a blood pressure reduction over 12 months.BackgroundEvidence indicates that the carotid bodies may contribute to the development of hypertension. Therefore it is a putative target for treating hypertension.

Methods

Fifteen participants with office blood pressure (BP) 179+7/106+4 mmHg on 5.7+0.3 antihypertensive drugs were studied at baseline and 1, 3, 6 and 12 months after removing either the right (n=11) or left (n=4) carotid body. Hypoxic ventilatory response (HVR), adverse events, polysomnography, blood pressure (office: OBP; ambulatory: ABP) and muscle sympathetic nerve activity (MSNA) were measured.

Results

Glomus cells were found in resected tissue from 14/15 patients confirming feasibility. Two serious adverse events developed: one related and the other unlikely related to the procedure. In all cases, the HVR was maintained. Overall, no change in OBP, ABP, MSNA or BRS was found (n=15). However, 8/14 patients responded with a reduction in ABP >10mmHg at 3 and 6 months (P<0.01) and MSNA (P<0.05). Respiratory frequency and HVR measured pre-operatively were higher in responders (P<0.05) compared to non-responders, consistent with increased carotid body drive.

Conclusions

Unilateral carotid body resection was feasible and safe. In 57% of patients ABP was lowered for at least 6 months associated with reduced MSNA and improved BRS. We conclude, some drug resistant hypertensive patients have increased carotid body drive.
Original languageEnglish
Pages (from-to)313-324
Number of pages12
JournalJournal of the American College of Cardiology
Volume1
Issue number5
Early online date29 Aug 2016
DOIs
Publication statusPublished - Aug 2016

Structured keywords

  • CRICBristol
  • Bristol Heart Institute

Keywords

  • Peripheral chemoreceptor
  • sympathetic nervous system
  • hypertension
  • afferent drive
  • baroreceptor reflex
  • hypoxia

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