Uncontrolled hypertension is a main risk factor for cardiovascular morbidity. Baroreflex activation therapy (BAT) is an effective therapy option addressing true resistant hypertension. We evaluated patients’ eligibility for BAT in a staged assessment as well as adherence to antihypertensive drug therapy. Therefore, we analyzed files of 345 patients, attending the hypertension clinic at University Medicine Göttingen. Additionally, gas chromatographic-mass spectrometric urine analyses of selected individuals were performed evaluating their adherence. Most common cause for a revoked BAT recommendation was blood pressure (BP) control by drug adjustment (54.2%). Second leading cause was presence of secondary hypertension (31.6%). Patients to whom BAT was recommended (59 (17.1%)) were significantly more often male (67.8% vs. 43.3%, P = .0063), had a higher body mass index (31.8 ± 5.8 vs. 30.0 ± 5.7 kg/m², P = .0436), a higher systolic office (168.7 ± 24.7 vs. 147.7 ± 24.1 mmHg, P < .0001), and 24h ambulatory BP (155.0 ± 14.6 vs. 144.4 ± 16.8 mmHg, P = .0031), took more antihypertensive drugs (5.8 ± 1.3 vs. 4.4 ± 1.4, P < .0001), and suffered more often from numerous concomitant diseases. Eventually, 27 (7.8%) received a BAT system. In the toxicological analysis of 75 patients, mean adherence was 75.1%. 16 patients (21.3%) showed non-adherence. Thus, only a small number of patients eventually received a BAT system, as treatable reasons for apparently resistant hypertension could be identified frequently. This study is—to our knowledge—the first report of a staged assessment of patients’ suitability for BAT and underlines the need for a careful examination and indication. Non-adherence was proven to be a relevant issue concerning apparently resistant hypertension and therefore non-eligibility for interventional antihypertensive therapy.

中文翻译：

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明显顽固性高血压患者接受压力反射激活疗法的资格和药物依从性

不受控制的高血压是心血管发病率的主要危险因素。压力反射激活疗法 (BAT) 是解决真正顽固性高血压的有效疗法。我们在分阶段评估中评估了患者接受 BAT 的资格以及对抗高血压药物治疗的依从性。因此，我们分析了在哥廷根大学医学院高血压诊所就诊的 345 名患者的档案。此外，对选定的个体进行气相色谱-质谱尿液分析，以评估他们的依从性。撤销 BAT 建议的最常见原因是通过药物调整控制血压 (54.2%)。第二个主要原因是继发性高血压（31.6%）。推荐 BAT 的患者 (59 (17.1%)) 明显更多是男性 (67.8% vs. 43.3%,P  = .0063)，具有更高的体重指数（31.8 ± 5.8 与 30.0 ± 5.7 kg/m²，P  = .0436），更高的收缩压办公室（168.7 ± 24.7 与 147.7 ± 24.1 mmHg，P  < .0001 ）和 24 小时动态血压（155.0 ± 14.6 对 144.4 ± 16.8 mmHg，P  = .0031），服用更多降压药（5.8 ± 1.3 对 4.4 ± 1.4，P < .0001），并且更常患有多种伴随疾病。最终，27 (7.8%) 收到了 BAT 系统。在 75 名患者的毒理学分析中，平均依从性为 75.1%。16 名患者 (21.3%) 表现出不依从性。因此，只有少数患者最终接受了 BAT 系统，因为可以经常确定明显顽固性高血压的可治疗原因。据我们所知，这项研究是第一份关于患者是否适合 BAT 的分阶段评估报告，并强调了仔细检查和适应症的必要性。不依从被证明是与明显顽固性高血压相关的问题，因此不符合介入抗高血压治疗的资格。