3052
NOVEL TECHNOLOGIES TO MANAGE BLOOD PRESSURE IN PATIENTS
WITH AUTONOMIC DYSFUNCTION
A. Diedrich1,2, F. Baudenbacher2, J. Jordan3, J. Tank3, K. Heusser3, S. Raj1,
D. Robertson1,4, I. Biaggioni1
1 Autonomic Dysfunction Center, Clinical Pharmacology, Vanderbilt University School
of Medicine, Nashville, USA
2 School of Biomedical Engineering, Vanderbilt University, Nashville, USA
3 Clinical Pharmacology, Medical School Hannover, Germany
4 Department of Neurology, Vanderbilt University, Nashville, USA
Autonomic dysfunction contributes to abnormalities in blood pressure and heart rate
control in young and elderly populations and causes significant disability. Supine
hypertension and orthostatic hypotension is a common picture in patients with autonomic
failure and are difficult to manage. Volatile blood pressure in patients with afferent
baroreflex failure is a challenge to control. Resistant hypertension can be difficult to treat
pharmacologically. Postural tachycardia syndrome is a heterogeneous entity difficult to
diagnose and manage.
Novel signal and hardware technologies can improve management of autonomic
baroreflex dysfunction and reduce health care costs. Spectral analysis of hemodynamic
parameters is a powerful tool if used appropriately. Electrical nerve stimulation or smart
infusions of vasoactive drugs are possible ways to prevent orthostatic hypotension.
Electric field stimulation of carotid baroreceptors elicits a depressor response through
sympathetic inhibition and can be applied to reduce hypertension. Endovascular renal
nerve ablation has been developed to treat resistant hypertension. Studies are under way
to prove the efficacy and safety of these interventions in different patients populations.
Wireless smart ambulatory autonomic health monitor systems utilizing accelerometer,
impedance techniques, and blood pressure can help in the diagnosis and prevention of
falls or syncope. These miniature wireless smart devices can potentially interface with
therapeutic devices for blood pressure control. Bionic baroreflex systems, originally
proposed decades ago, will be possible soon in human subjects. The integration of these
techniques into a smart health care informatics system will complement and improve the
management of the cardiovascular abnormalities associated with autonomic dysfunction
in the clinic and at home.