High blood pressure can be so taxing on the heart that, unchecked, it will eventually cause an otherwise healthy heart to overwork itself and quit -- not to mention spur a host of other difficulties, such as rendering the heart muscle so thick it can look like a liver.

So it's understandable that many cardiologists, in an effort to get to the root of the myriad health problems that stem from hypertension, have focused on alleviating the condition with drugs. But patients whose extreme hypertension won't respond to medication or changes in lifestyle may soon have a new option to lower their blood pressure: surgery.

A multi-center, 300-patient trial led by researchers at Columbia University Medical Center (CUMC) and New York-Presbyterian Hospital is testing the efficacy of the Rheos Baroreflex Hypertension Therapy System. The Food and Drug Administration-approved system is implanted surgically, with minimal scarring, under the skin in the neck and electronically stimulates the receptors in the carotid sinus, the area located at the bifurcations of the carotid arteries that are responsible for regulating blood pressure.
"One-third of the world's population is hypertensive, and only one-third of those people can only control their hypertension with the help of drugs," says Dr. Daichi Shimbo, assistant professor in the Center for Behavioral Cardiovascular Health at Columbia University Medical Center and the medical principal investigator for the multi-center trial. "There is a vast segment of the hypertensive population that could potentially benefit from surgically intervening to alter the way baroreceptors function."

Baroreceptors work like a thermostat that automatically turns on the air conditioning when the air temperature becomes too hot. By activating the baroreceptors and sending signals to the brain, the Rheos System causes the brain to perceive a rise in blood pressure. The brain then acts to reduce blood pressure by sending signals to the blood vessels, heart and kidneys, the major organ systems involved in the control of blood pressure.

"The system is designed to work by stimulating the baroreceptors in the carotid sinus to make it appear as if patients are more hypertensive than they really are, forcing the body to respond and lower blood pressure," said Thomas Pickering, M.D., director of the CUMC Center for Behavioral Cardiovascular Health, and the national principal investigator of the trial. "For patients who have been unsuccessful at lowering extremely high blood pressures with the current pharmacological therapies, this device may be an invaluable option."

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