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Georg-August-Universität Göttingen

1. Lehnig, Luca-Yves. Analyse organoprotektiver Effekte durch eine Barorezeptorstimulationstherapie zur Behandlung der Therapie-refraktären arteriellen Hypertonie.

Degree: PhD, Medizinische Fakultät, 2017, Georg-August-Universität Göttingen

Cardiovascular disease accounts for 50% of the causes of death. The arterial hypertension (aHTN) is the main risk factor for cardiovascular morbidity and mortality and shows a prevalence of almost 40% in the European population. However, an uncontrolled aHTN or even a resistant Hypertension is present in more than 50% of patients with hypertension. The Baroreflex Activation Therapy (BAT) is a new interventional procedure for the treatment of patients with resistant hypertension. Chronic electrical stimulation of baroreceptors at the carotid sinus causes a modulation of the vegetative nervous system via afferent nerve fibers. This results in an inhibition of the sympathetic upon activation of the parasympathetic nervous system. The blood pressure-lowering effects of the BAT could already be demonstrated in a double-blind study (Rheos Pivotal Trial). Whether the inhibition of the sympathetic nervous system by BAT provides organoprotective effects on the kidneys and the vascular system was not yet investigated and is subject of the present study. Possible side effects of this invasive therapy have been insufficiently investigated so far. A total of 31 patients were examined before and 6 months after BAT activation in a prospective non-randomized non-controlled observation study. The office blood pressure reduced significantly after 6 months while the ambulatory blood pressure measurement showed a trend towards reduction but no statistical significance was achieved at this time. A with reduction of blood pressure a significant decrease of proteinuria and albuminuria as well as an increase in urine sodium excretion could be detected. In addition, there was a significant improvement in central hemodynamics with a reduction in central blood pressure as well as pulse wave velocity and augmentation index. Proteomic analysis of urine by 2D gel electrophoresis and mass spectrometry revealed a significant decrease of endoplasmic reticulum stress proteins (ERP57; GRP78). Considering the proliferative capacity of endothelial progenitor cells and pro-angiogenic markers BAT showed no effect during the investigation period. The results should be interpreted critical. An open labeled study design and low number of included patients limit the present study. The data obtained contribute to a concept in which the inhibition of the overactive sympathetic nervous system in patients with resistant Hypertension could cause nephroprotection and improve central hemodynamics in addition to lowering blood pressure. In consequence, BAT could contribute to a reduction of cardiovascular risk. The data ascertained could be basis of further randomized controlled trials examining BAT and verify our results.

Herz-Kreislauferkrankungen sind für 50 % der Todesursachen verantwortlich. Dabei stellt die arterielle Hypertonie den Hauptrisikofaktor für kardiovaskuläre Morbidität und Mortalität dar und zeigt eine Prävalenz von fast 40 % in der europäischen Bevölkerung. Bei mehr als 50% der Hypertoniker liegt jedoch eine unkontrollierte…

Advisors/Committee Members: Wallbach, Manuel (advisor), Koziolek, Michael (referee), Wachter, Rolf (referee), Oppermann, Martin (referee).

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APA (6th Edition):

Lehnig, L. (2017). Analyse organoprotektiver Effekte durch eine Barorezeptorstimulationstherapie zur Behandlung der Therapie-refraktären arteriellen Hypertonie. (Doctoral Dissertation). Georg-August-Universität Göttingen. Retrieved from http://hdl.handle.net/11858/00-1735-0000-0023-3DC3-0

Chicago Manual of Style (16th Edition):

Lehnig, Luca-Yves. “Analyse organoprotektiver Effekte durch eine Barorezeptorstimulationstherapie zur Behandlung der Therapie-refraktären arteriellen Hypertonie.” 2017. Doctoral Dissertation, Georg-August-Universität Göttingen. Accessed September 24, 2017. http://hdl.handle.net/11858/00-1735-0000-0023-3DC3-0.

MLA Handbook (7th Edition):

Lehnig, Luca-Yves. “Analyse organoprotektiver Effekte durch eine Barorezeptorstimulationstherapie zur Behandlung der Therapie-refraktären arteriellen Hypertonie.” 2017. Web. 24 Sep 2017.

Vancouver:

Lehnig L. Analyse organoprotektiver Effekte durch eine Barorezeptorstimulationstherapie zur Behandlung der Therapie-refraktären arteriellen Hypertonie. [Internet] [Doctoral dissertation]. Georg-August-Universität Göttingen; 2017. [cited 2017 Sep 24]. Available from: http://hdl.handle.net/11858/00-1735-0000-0023-3DC3-0.

Council of Science Editors:

Lehnig L. Analyse organoprotektiver Effekte durch eine Barorezeptorstimulationstherapie zur Behandlung der Therapie-refraktären arteriellen Hypertonie. [Doctoral Dissertation]. Georg-August-Universität Göttingen; 2017. Available from: http://hdl.handle.net/11858/00-1735-0000-0023-3DC3-0

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