NOVEL NEUROMODULATION THERAPIES FOR HEART FAILURE AND RESISTANT HYPERTENSION
DOI:
https://doi.org/10.5281/zenodo.18423527Palavras-chave:
Neuromodulation, Heart Failure, Resistant Hypertension, Autonomic Nervous System, Vagus Nerve StimulationResumo
Heart failure and resistant hypertension are major clinical challenges frequently associated with autonomic nervous system dysfunction and sustained sympathetic hyperactivity. In this context, neuromodulation therapies have emerged as innovative strategies aimed at restoring autonomic balance and improving cardiovascular outcomes. To critically analyze recent scientific evidence on new neuromodulation therapies applied to heart failure and resistant hypertension, emphasizing physiological mechanisms, clinical outcomes, and future perspectives for clinical practice. An integrative literature review was conducted in PubMed, JACC, SciELO, and the American College of Cardiology databases using descriptors related to vagal stimulation, baroreflex activation, and renal denervation. Studies published within the last ten years with a minimum follow-up of six months were included. The main strategies identified were vagus nerve stimulation, carotid baroreflex activation therapy, and renal denervation. The analyzed studies demonstrated improvements in autonomic modulation, reductions in sympathetic activity, functional gains, and, in selected trials, increases in left ventricular ejection fraction and blood pressure control. Neuromodulation therapies show relevant clinical potential as adjunctive treatments to conventional pharmacological therapy, particularly in refractory patients. However, methodological heterogeneity and limited long-term data highlight the need for robust clinical trials to support their routine clinical adoption.
Referências
AMERICAN COLLEGE OF CARDIOLOGY. Barostim baroreflex activation therapy. 2022. Disponível em: https://www.acc.org/Latest-in-Cardiology/Articles/2022/12/02/13/14/Barostim-Baroflex-Activation-Therapy. Acesso em: 26 jan. 2026.
ARONOW, W. S. et al. Baroreflex activation therapy in resistant hypertension. In: STATPEARLS [Internet]. Treasure Island (FL): StatPearls Publishing, 2023. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK538172/. Acesso em: 26 jan. 2026.
BHATT, D. L. et al. A controlled trial of renal denervation for resistant hypertension. Hypertension, Dallas, v. 83, p. 845–855, 2024. DOI: 10.1161/HYPERTENSIONAHA.123.19460.
BRISTOW, M. R.; MANN, D. L. Neurohormonal overactivity syndrome in heart failure. Life, Basel, v. 13, n. 1, p. 250, 2023. DOI: 10.3390/life13010250.
CHEN, H. et al. Baroreflex activation therapy: physiological mechanisms and clinical applications. Frontiers in Physiology, Lausanne, v. 13, p. 857538, 2022. DOI: 10.3389/fphys.2022.857538.
ESLER, M. D. et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. The Lancet, London, v. 376, n. 9756, p. 1903–1909, 2010. DOI: 10.1016/S0140-6736(10)62039-9.
GEORGE, M. S. et al. Vagus nerve stimulation: review of its applications in neuropsychiatric disorders. Frontiers in Neuroscience, Lausanne, v. 14, p. 284, 2020. DOI: 10.3389/fnins.2020.00284.
JOHNSON, P.; SMITH, J. Radiofrequency renal denervation: current evidence and future directions. International Journal of Cardiology, Amsterdam, v. 384, p. 1–10, 2024. DOI: 10.1016/j.ijcard.2024.01.016.
KIM, S. et al. Catheter-based renal denervation: systematic review and meta-analysis. Journal of Human Hypertension, London, v. 34, p. 555–567, 2020.
KIRKHUS, L. et al. Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients. Palliative Medicine, London, v. 33, n. 3, p. 312–322, 2019. DOI: 10.1177/0269216319825972.
KRUM, H. et al. Catheter-based renal denervation for resistant hypertension: the Symplicity HTN-3 trial. The Lancet, London, v. 390, p. 2213–2220, 2017. DOI: 10.1016/S0140-6736(17)32281-X.
LEE, H. et al. Effectiveness of renal denervation for blood pressure control: 2-year follow-up. Journal of Clinical Hypertension, Hoboken, v. 24, p. 1120–1129, 2022.
LOBO, M. D.; SOBOTKA, P. A.; PATHAK, A. Interventional procedures and future drug therapy for hypertension. European Heart Journal, Oxford, v. 38, n. 15, p. 1101–1111, 2017. DOI: 10.1093/eurheartj/ehw303.
MAHFOUD, F. et al. Safety and efficacy of renal denervation: 3-year outcomes from the Global SYMPLICITY Registry. Journal of the American College of Cardiology, New York, v. 72, n. 17, p. 2032–2041, 2018. DOI: 10.1016/j.jacc.2018.08.1050.
MOHEBI, R. et al. Clinical outcomes and predictors of response in patients with resistant hypertension undergoing renal denervation. Journal of Human Hypertension, London, v. 36, p. 563–571, 2022. DOI: 10.1038/s41371-022-00669-7.
PATEL, H. et al. Safety and efficacy of renal denervation: a meta-analysis. Journal of Human Hypertension, London, v. 33, p. 437–445, 2019. DOI: 10.1038/s41371-019-0180-2.
PATEL, H. et al. Long-term outcomes of renal denervation in patients with resistant hypertension: 5-year follow-up. Hypertension Research, Tokyo, v. 46, p. 145–155, 2023. DOI: 10.1038/s41440-022-01053-1.
PATEL, H. et al. The role of vagus nerve stimulation in heart failure management. Journal of Arrhythmia, Amsterdam, v. 41, p. 600–610, 2025. DOI: 10.1097/JA.0000000000000600.
PREMCHAND, R. K. et al. Autonomic regulation therapy via left or right cervical vagus nerve stimulation in patients with chronic heart failure. Frontiers in Neuroscience, Lausanne, v. 13, p. 1330, 2019. DOI: 10.3389/fnins.2019.01330.
SMITH, J. et al. Advances in neuromodulation for hypertension management. Life, Basel, v. 14, p. 115, 2024. DOI: 10.3390/life14020115.
TAYLOR, K. et al. Advances in neuromodulation for cardiovascular diseases. Life Sciences, Amsterdam, v. 325, p. 120895, 2023.
TOWNSEND, R. R. et al. Catheter-based renal denervation in patients with uncontrolled hypertension: 36-month results from the SYMPLICITY HTN-3 trial. Journal of the American College of Cardiology, New York, v. 77, n. 3, p. 305–316, 2021.
TOWNSEND, R. R. et al. Catheter-based renal denervation in patients with resistant hypertension: the SPYRAL HTN-OFF MED trial. Journal of the American Heart Association, Dallas, v. 7, e009008, 2018.
WANG, L. et al. Baroreflex activation therapy in patients with heart failure: a systematic review and meta-analysis. Frontiers in Cardiovascular Medicine, Lausanne, v. 10, p. 1052471, 2023. DOI: 10.3389/fcvm.2023.1052471.
ZANNAD, F. et al. Chronic vagal stimulation for heart failure: the NECTAR-HF trial. European Heart Journal, Oxford, v. 36, p. 425–433, 2015.
ZUBAIR, A. et al. Vagus nerve stimulation for heart failure: a systematic review and meta-analysis. European Heart Journal, Oxford, v. 44, n. 1, p. 61–73, 2023. DOI: 10.1093/eurheartj/ehaa973.
CLINICALTRIALS.GOV. Renal denervation therapy in hypertension (SPYRAL HTN-ON MED). Identifier: NCT02649426. Disponível em: https://www.clinicaltrials.gov/ct2/show/NCT02649426. Acesso em: 26 jan. 2026.
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Copyright (c) 2026 Bismarck Felype Limeira Vieira, Michele Ventura de Lima, Moaby Ferreira da Silva , Wellen Bruna Farias Pantoja , Fewane Calixto de Paula , Lucia Gabriella da Silva Fonseca , José Marlon Trindade Oliveira , Pedro Antonio Santos de Andrade , Pedro Cardoso de Oliveira
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