Long-Term Efficacy and Safety of First- and Second-Generation Baroreflex Activation Devices in Refractory Hypertension: A Single Center Retrospective Analysis

Baroreflex activation therapy (BAT) has emerged as a device-based therapy for resistant hypertension. Comparative evidence between first-generation (Rheos®) and second-generation (Barostim Neo™) BAT systems remains limited. We retrospectively analysed all patients who underwent BAT implantation between 2006 and 2015 (n = 54) at our centre. The primary outcome was the change in 24h ambulatory blood pressure monitoring (ABPM) between device generations. Secondary outcomes included adverse events, major adverse cardiovascular events (MACE), kidney function, and device-related complications. Office blood pressure, 24h ABPM, and heart rate (HR) were assessed at baseline and during follow-up. Patients with insufficient 24h ABPM follow-up data were excluded from the primary endpoint analysis. In patients with ABPM data (n = 33), BAT significantly reduced 24h diastolic blood pressure (DBP), 24h systolic blood pressure (SBP), and HR (all p < 0.05). Daytime SBP, DBP, and HR decreased significantly. At night, SBP declined from 165 to 151 mmHg (p = 0.004) and DBP from 98 to 88 mmHg (p = 0.003), while HR remained unchanged. Rheos® was associated with significant reductions in 24h and night-time SBP; daytime SBP decreased numerically but did not reach statistical significance. Barostim Neo™ (n = 14) reduced 24h and daytime HR (p = 0.006 and p = 0.009) but showed no statistically significant BP reduction. No significant differences were observed between devices in complication rates, kidney function, or MACE. Baroreflex activation was safe and associated with reductions in 24h blood pressure and heart rate in patients with resistant hypertension. The first-generation Rheos® system demonstrated more pronounced blood pressure–lowering effects, whereas the second-generation Neo™ system was associated primarily with heart rate reduction without a significant effect on blood pressure. Although Rheos® is no longer commercially available, these findings highlight the importance of electrode design, implantation strategy, and patient selection in optimising the efficacy of contemporary BAT. Resistant hypertension means blood pressure remains high despite taking at least three antihypertensive drugs, including a diuretic. Baroreflex activation therapy (BAT) is a device-based treatment that stimulates the carotid baroreceptors to reduce sympathetic nerve activity and lower blood pressure. Two BAT systems are available: the first-generation Rheos® (bilateral electrodes with finger shaped probe) and the second-generation Barostim Neo™ (unilateral electrode with a smaller generator and small button-shaped probe). This study compared the effects and safety of both systems in patients treated at Hannover Medical School between 2006 and 2015. Data from 54 patients with resistant hypertension were analysed; 33 had complete follow-up data for ambulatory blood pressure and heart rate. Measurements included office and 24-hour blood pressure, heart rate, kidney function, adverse events, and battery replacements. Overall, BAT significantly reduced 24h-systolic and diastolic blood pressure as well as heart rate. Night-time blood pressure decreased markedly, while daytime reductions were smaller but still significant. The Rheos® device showed stronger blood pressure reductions, especially at night. The Neo™ device lowered heart rate significantly but had smaller blood pressure effects. Both devices demonstrated good long-term safety with no major differences in complications or kidney function. Battery life was substantially longer with the second-generation Neo™ system. BAT offers a safe and effective treatment option for patients with resistant hypertension who do not respond to medication. Device design, electrode placement, and patient selection may influence treatment success.