Peripheral Chemoreflex/Arterial Baroreflex Interaction in Patients With Electrical Carotid Sinus Stimulation
NCT ID: NCT02587533
Last Updated: 2018-01-09
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
COMPLETED
NA
11 participants
INTERVENTIONAL
2015-11-30
2017-12-31
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Multidisciplinary Study to Verify Blood Pressure Documentation and Response to Titration of Intravenous Medications
NCT06253780
Autonomic Regulation of Blood Pressure in Premature and Early Menopausal Women
NCT04439370
Exercise and Blood Pressure Reactivity
NCT01935895
Overnight Trials With Heat Stress in Autonomic Failure Patients With Supine Hypertension
NCT03042988
Do Home Monitors Improve Blood Pressure Control?
NCT01579136
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Patients will be investigated in the post-absorptive state after emptying their bladder. During instrumentation and measurements they will rest in supine position. We will fix chest electrodes for ECG and impedance cardiography. A peripheral venous catheter will be introduced for later dopamine infusion. Cuffs will be used at the upper arm and the finger in order to monitor blood pressure and to allow for pulse-contour analysis. Finally, we will search for a suitable nerve recording position in the peroneal nerve for recordings of muscle sympathetic nerve activity (MSNA, postganglionic vasoconstrictor sympathetic drive). All bioelectric signals will be recorded continuously for the duration of the experiments.
After the preparations baseline recordings will be performed. Subsequently, the electrical baroreflex stimulator is switched OFF and ON repeatedly (toggling) under normoxic conditions. Every OFF and ON state will last for 4 minutes. Oscillometric blood-pressure readings are taken every two minutes so as to acquire two readings per stimulation period. Toggling under normoxia is meant to ensure that the patient is a responder at the experimental day and to rule out that the blood pressure rises are too high off stimulation (safety concern). Afterwards, the breathing gas will be changed in order to have the patient inhale a hypoxic or hyperoxic mixture in a blinded manner. After reaching a stable ventilatory and autonomic state, stimulator toggling and blood-pressure measurements will be repeated. The same procedures will take place after establishing the opposite oxygenation state. Stimulation will be ON in between the oxygen states implying that the first switches will be OFF switches with all oxygenation conditions. Afterwards, the last oxygenation state will be maintained and additional low-dose dopamine infusion will be applied. Again, the electrical baroreflex stimulator will be switched off and on repeatedly and blood-pressure readings are taken. During the last two stimulator toggling states of each oxygenation level, venous blood samples are drawn for hormone measurements and inert gas rebreathing will take place for cardiac output determination. Finally, the correct positioning of the microneurography electrode is checked again.
The duration of such an experiment depends on the time needed to find the sympathetic nerve bundles before the measurements and during the experiment, in case the recording position gets lost. However, experiments will rarely exceed 5 hours in total.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
RANDOMIZED
CROSSOVER
BASIC_SCIENCE
SINGLE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
Hypoxia without dopamine
Target hemoglobin oxygen saturation (SpO2) 80%. No pharmacologic suppression of chemoreflex afferents. Readout: Responses to electrical baroreflex stimulation.
Hypoxia without dopamine
Target hemoglobin oxygen saturation (SpO2) 80%.
Hypoxia with dopamine
Target hemoglobin oxygen saturation (SpO2) 80%. Counteracting pharmacologic suppression of chemoreflex afferents. Readout: Responses to electrical baroreflex stimulation.
Hypoxia with dopamine
Target hemoglobin oxygen saturation (SpO2) 80%. Dopamine dose 3 µg/kg/min.
Hyperoxia without dopamine
Nearly complete hemoglobin oxygen saturation. No additional pharmacologic suppression of chemoreflex afferents. Readout: Responses to electrical baroreflex stimulation.
Hyperoxia without dopamine
Nearly complete hemoglobin oxygen saturation.
Hyperoxia with dopamine
Nearly complete hemoglobin oxygen saturation. Additional pharmacologic suppression of chemoreflex afferents. Readout: Responses to electrical baroreflex stimulation.
Hyperoxia with dopamine
Nearly complete hemoglobin oxygen saturation. Dopamine dose 3 µg/kg/min.
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
Hypoxia without dopamine
Target hemoglobin oxygen saturation (SpO2) 80%.
Hypoxia with dopamine
Target hemoglobin oxygen saturation (SpO2) 80%. Dopamine dose 3 µg/kg/min.
Hyperoxia without dopamine
Nearly complete hemoglobin oxygen saturation.
Hyperoxia with dopamine
Nearly complete hemoglobin oxygen saturation. Dopamine dose 3 µg/kg/min.
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
* The patient is a 'responder', i. e. carotid-sinus stimulation causes a drop in systolic arterial pressure by at least 15 mmHg.
* The patient gave informed consent.
Exclusion Criteria
* The mental condition renders the patient unable to understand the nature, scope, and possible consequences of the study.
* The patient is unlikely to comply with the protocol.
* The patient is pregnant or breast-feeding.
* Hypoxic conditions for half an hour are considered harmful, e. g. in patients with shunts.
* History of drug or alcohol abuse.
* Discontinuation of diuretic medication for one day is considered harmful. (Reason: Bladder distension is a sympathoexcitatory stimulus and shortens experimental time. In order to prevent these shortcomings three measures are taken: Dispensation with beverages and diuretics as well as complete bladder voiding immediately before the experiment.)
18 Years
ALL
No
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
Charite University, Berlin, Germany
OTHER
Vanderbilt University School of Medicine
OTHER
Mayo Clinic
OTHER
University of Bristol
OTHER
Hannover Medical School
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Principal Investigators
Learn about the lead researchers overseeing the trial and their institutional affiliations.
Jens Tank, MD
Role: PRINCIPAL_INVESTIGATOR
Hannover Medical School
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
Hannover Medical School
Hanover, LSX, Germany
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
Grassi G. Counteracting the sympathetic nervous system in essential hypertension. Curr Opin Nephrol Hypertens. 2004 Sep;13(5):513-9. doi: 10.1097/00041552-200409000-00006.
Eckberg DL. Carotid baroreflex function in young men with borderline blood pressure elevation. Circulation. 1979 Apr;59(4):632-6. doi: 10.1161/01.cir.59.4.632.
Somers VK, Mark AL, Abboud FM. Potentiation of sympathetic nerve responses to hypoxia in borderline hypertensive subjects. Hypertension. 1988 Jun;11(6 Pt 2):608-12. doi: 10.1161/01.hyp.11.6.608.
Trzebski A, Tafil M, Zoltowski M, Przybylski J. Increased sensitivity of the arterial chemoreceptor drive in young men with mild hypertension. Cardiovasc Res. 1982 Mar;16(3):163-72. doi: 10.1093/cvr/16.3.163.
McBryde FD, Abdala AP, Hendy EB, Pijacka W, Marvar P, Moraes DJ, Sobotka PA, Paton JF. The carotid body as a putative therapeutic target for the treatment of neurogenic hypertension. Nat Commun. 2013;4:2395. doi: 10.1038/ncomms3395.
Abdala AP, McBryde FD, Marina N, Hendy EB, Engelman ZJ, Fudim M, Sobotka PA, Gourine AV, Paton JF. Hypertension is critically dependent on the carotid body input in the spontaneously hypertensive rat. J Physiol. 2012 Sep 1;590(17):4269-77. doi: 10.1113/jphysiol.2012.237800. Epub 2012 Jun 11.
Sinski M, Lewandowski J, Przybylski J, Bidiuk J, Abramczyk P, Ciarka A, Gaciong Z. Tonic activity of carotid body chemoreceptors contributes to the increased sympathetic drive in essential hypertension. Hypertens Res. 2012 May;35(5):487-91. doi: 10.1038/hr.2011.209. Epub 2011 Dec 8.
Paton JF, Deuchars J, Li YW, Kasparov S. Properties of solitary tract neurones responding to peripheral arterial chemoreceptors. Neuroscience. 2001;105(1):231-48. doi: 10.1016/s0306-4522(01)00106-3.
Somers VK, Mark AL, Abboud FM. Interaction of baroreceptor and chemoreceptor reflex control of sympathetic nerve activity in normal humans. J Clin Invest. 1991 Jun;87(6):1953-7. doi: 10.1172/JCI115221.
Paton JF, Sobotka PA, Fudim M, Engelman ZJ, Hart EC, McBryde FD, Abdala AP, Marina N, Gourine AV, Lobo M, Patel N, Burchell A, Ratcliffe L, Nightingale A. The carotid body as a therapeutic target for the treatment of sympathetically mediated diseases. Hypertension. 2013 Jan;61(1):5-13. doi: 10.1161/HYPERTENSIONAHA.111.00064. Epub 2012 Nov 19. No abstract available.
Despas F, Lambert E, Vaccaro A, Labrunee M, Franchitto N, Lebrin M, Galinier M, Senard JM, Lambert G, Esler M, Pathak A. Peripheral chemoreflex activation contributes to sympathetic baroreflex impairment in chronic heart failure. J Hypertens. 2012 Apr;30(4):753-60. doi: 10.1097/HJH.0b013e328350136c.
Wennergren G, Little R, Oberg B. Studies on the central integration of excitatory chemoreceptor influences and inhibitory baroreceptor and cardiac receptor influences. Acta Physiol Scand. 1976 Jan;96(1):1-18. doi: 10.1111/j.1748-1716.1976.tb10166.x.
Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S, Peters T, Sweep FC, Haller H, Pichlmaier AM, Luft FC, Jordan J. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension. 2010 Mar;55(3):619-26. doi: 10.1161/HYPERTENSIONAHA.109.140665. Epub 2010 Jan 25.
Schroeder C, Heusser K, Brinkmann J, Menne J, Oswald H, Haller H, Jordan J, Tank J, Luft FC. Truly refractory hypertension. Hypertension. 2013 Aug;62(2):231-5. doi: 10.1161/HYPERTENSIONAHA.113.01240. Epub 2013 May 20. No abstract available.
Jordan J, Heusser K, Brinkmann J, Tank J. Electrical carotid sinus stimulation in treatment resistant arterial hypertension. Auton Neurosci. 2012 Dec 24;172(1-2):31-6. doi: 10.1016/j.autneu.2012.10.009. Epub 2012 Nov 9.
Janssen C, Beloka S, Kayembe P, Deboeck G, Adamopoulos D, Naeije R, van de Borne P. Decreased ventilatory response to exercise by dopamine-induced inhibition of peripheral chemosensitivity. Respir Physiol Neurobiol. 2009 Sep 30;168(3):250-3. doi: 10.1016/j.resp.2009.07.010. Epub 2009 Jul 18.
Niewinski P, Tubek S, Banasiak W, Paton JF, Ponikowski P. Consequences of peripheral chemoreflex inhibition with low-dose dopamine in humans. J Physiol. 2014 Mar 15;592(6):1295-308. doi: 10.1113/jphysiol.2013.266858. Epub 2014 Jan 6.
Niewinski P, Janczak D, Rucinski A, Jazwiec P, Sobotka PA, Engelman ZJ, Fudim M, Tubek S, Jankowska EA, Banasiak W, Hart EC, Paton JF, Ponikowski P. Carotid body removal for treatment of chronic systolic heart failure. Int J Cardiol. 2013 Oct 3;168(3):2506-9. doi: 10.1016/j.ijcard.2013.03.011. Epub 2013 Mar 29.
Lipp A, Schmelzer JD, Low PA, Johnson BD, Benarroch EE. Ventilatory and cardiovascular responses to hypercapnia and hypoxia in multiple-system atrophy. Arch Neurol. 2010 Feb;67(2):211-6. doi: 10.1001/archneurol.2009.321.
Breskovic T, Valic Z, Lipp A, Heusser K, Ivancev V, Tank J, Dzamonja G, Jordan J, Shoemaker JK, Eterovic D, Dujic Z. Peripheral chemoreflex regulation of sympathetic vasomotor tone in apnea divers. Clin Auton Res. 2010 Apr;20(2):57-63. doi: 10.1007/s10286-009-0034-1. Epub 2009 Oct 10.
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
CRC-KliPha-004
Identifier Type: -
Identifier Source: org_study_id
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.