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

doi:10.1016/j.jacbts.2016.06.004

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 journal › Article (Academic Journal) › peer-review

157 Citations (Scopus)

458 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 language	English
Pages (from-to)	313-324
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	1
Issue number	5
Early online date	29 Aug 2016
DOIs	https://doi.org/10.1016/j.jacbts.2016.06.004
Publication status	Published - Aug 2016

Research Groups and Themes

CRICBristol
Bristol Heart Institute
Engineering Mathematics Research Group

Keywords

Peripheral chemoreceptor
sympathetic nervous system
hypertension
afferent drive
baroreceptor reflex
hypoxia

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10.1016/j.jacbts.2016.06.004

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Modeling the respiratory-sympathetic coupling in neurogenic hypertension
Abdala Sheikh, A. P. (Principal Investigator)
1/03/15 → 5/01/16
Project: Research
Carotid body ablation to treat sympathetic-overactivity: pre-clinical and clinical studies
Abdala Sheikh, A. P. (Co-Investigator) & Paton, J. F. R. (Principal Investigator)
1/01/12 → 31/01/14
Project: Research

Clinical Research and Imaging Centre (CRICBristol)
Thai, J. (Manager), Bucciarelli-Ducci, C. (Other) & Gilchrist, I. (Other)
Bristol Medical School (THS)
Facility/equipment: Facility

Dr Emma C J Hart
- Emma.Hartbristol.acuk
- Bristol Medical School - Senior Lecturer
- Bristol Neuroscience
Person: Academic , Member

Cite this

Narkiewicz, K., Ratcliffe, L., Hart, E., Briant, L., Chrostowska, M., Wolf, J., Szyndler, A., Hering, D., Abdala Sheikh, A. A., Manghat, N. E., Burchell, A., Durant, C., Lobos, M. D., Sobotka, P. A., Patel, N., Leiter, J. C., Engelman, Z. J., Nightingale, A., & Paton, J. (2016). Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial. Journal of the American College of Cardiology, 1(5), 313-324. https://doi.org/10.1016/j.jacbts.2016.06.004

@article{3e78ce5a7c054596a38e6b60bed3539f,

title = "Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial",

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.",

keywords = "Peripheral chemoreceptor, sympathetic nervous system, hypertension, afferent drive, baroreceptor reflex, hypoxia",

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

year = "2016",

month = aug,

doi = "10.1016/j.jacbts.2016.06.004",

language = "English",

volume = "1",

pages = "313--324",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "5",

}

Narkiewicz, K, Ratcliffe, L, Hart, E, Briant, L, Chrostowska, M, Wolf, J, Szyndler, A, Hering, D, Abdala Sheikh, AA, Manghat, NE, Burchell, A, Durant, C, Lobos, MD, Sobotka, PA, Patel, N, Leiter, JC, Engelman, ZJ, Nightingale, A & Paton, J 2016, 'Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial', Journal of the American College of Cardiology, vol. 1, no. 5, pp. 313-324. https://doi.org/10.1016/j.jacbts.2016.06.004

TY - JOUR

T1 - Unilateral Carotid Body Resection in Resistant Hypertension

T2 - A Safety and Feasibility Trial

AU - Narkiewicz, Krzysztof

AU - Ratcliffe, Laura

AU - Hart, Emma

AU - Briant, Linford

AU - Chrostowska, Marzena

AU - Wolf, Jacek

AU - Szyndler, Anna

AU - Hering, Dagmara

AU - Abdala Sheikh, Ana Abdala

AU - Manghat, Nathan E.

AU - Burchell, Amy

AU - Durant, Claire

AU - Lobos, Melvin D

AU - Sobotka, Paul A

AU - Patel, Nik

AU - Leiter, James C

AU - Engelman, Zoar J

AU - Nightingale, Angus

AU - Paton, Julian

PY - 2016/8

Y1 - 2016/8

N2 - 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.

AB - 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.

KW - Peripheral chemoreceptor

KW - sympathetic nervous system

KW - hypertension

KW - afferent drive

KW - baroreceptor reflex

KW - hypoxia

U2 - 10.1016/j.jacbts.2016.06.004

DO - 10.1016/j.jacbts.2016.06.004

M3 - Article (Academic Journal)

C2 - 27766316

SN - 0735-1097

VL - 1

SP - 313

EP - 324

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 5

ER -

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

Abstract

Research Groups and Themes

Keywords

Access to Document

Handle.net

Embargoed Document

Fingerprint

Projects

Modeling the respiratory-sympathetic coupling in neurogenic hypertension

Carotid body ablation to treat sympathetic-overactivity: pre-clinical and clinical studies

Equipment

Clinical Research and Imaging Centre (CRICBristol)

Profiles

Dr Emma C J Hart

Cite this