From the Guidelines
Electrical stimulation should not be used to control hypertension outside of clinical studies and RCTs, due to limited evidence on its safety and efficacy. When considering the management of elevated blood pressure and hypertension, the 2024 ESC guidelines 1 provide valuable insights. The guidelines discuss the use of device-based therapies, such as renal denervation, which may be considered for resistant hypertension patients who have uncontrolled blood pressure despite multiple medications. However, this approach is only recommended in specific contexts, such as medium-to-high volume centers, and after a shared risk-benefit discussion and multidisciplinary assessment. Key points to consider include:
- Renal denervation may be considered for patients with resistant hypertension and uncontrolled blood pressure despite a three-drug combination, including a thiazide or thiazide-like diuretic 1.
- The procedure should only be performed at a medium-to-high volume center, and patients should express a preference for renal denervation after a shared risk-benefit discussion and multidisciplinary assessment 1.
- Renal denervation is not recommended as a first-line BP-lowering intervention for hypertension, due to a lack of adequately powered outcomes trials demonstrating its safety and CVD benefits 1. It is essential to prioritize the safety and efficacy of treatments, and electrical stimulation should only be considered in the context of clinical studies and RCTs, until further evidence becomes available. In real-life clinical practice, it is crucial to exercise caution and adhere to established guidelines, rather than relying on unproven or experimental therapies. The primary goal should always be to minimize morbidity, mortality, and improve quality of life for patients with hypertension.
From the Research
Electrical Stimulation and Hypertension Control
- Electrical stimulation has been explored as a potential method for controlling hypertension, with various studies investigating its effects on blood pressure regulation.
- Transcutaneous electrical acupoint stimulation (TEAS) has been shown to contribute to blood pressure control, with a study finding that TEAS at a frequency of 10Hz resulted in significant reductions in systolic blood pressure compared to a control group 2.
- Baroreflex stimulation, which involves electrical stimulation of the carotid sinus, has also been found to reduce blood pressure by activating the baroreflex and reducing sympathetic tone 3, 4, 5.
- Selective vagal nerve stimulation has also been investigated as a method for reducing blood pressure, with a study finding that it can reduce blood pressure without significant side effects 6.
Mechanisms of Action
- The mechanisms by which electrical stimulation controls hypertension are thought to involve the activation of the baroreflex, which inhibits renal sympathetic tone and reduces blood pressure 3, 4.
- The baroreflex is a critical component of blood pressure regulation, and its activation has been shown to attenuate chronic hypertension 3.
- Electrical stimulation of the carotid sinus has been found to activate the baroreflex, resulting in a reduction in blood pressure and heart rate 4.
Potential Therapeutic Applications
- Electrical stimulation may be a useful adjunctive therapy for hypertension, particularly in patients with resistant hypertension 3, 5.
- The use of implantable carotid sinus stimulators has been proposed as a potential therapeutic option for patients with resistant hypertension 3, 5.
- Further research is needed to fully explore the potential therapeutic applications of electrical stimulation for hypertension control.