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107 Mobbs D, Marchant JL, Hassabis D et al. From threat to fear: the neural organization of defensive fear systems in humans. J Neurosci 2009;29(39):12236–43. 108 Critchley HD, Melmed RN, Featherstone E, Mathias CJ, Dolan RJ. Volitional control of autonomic arousal: a functional magnetic resonance study. Neuroimage 2002;16(4):909–19. 19 Chapter 2 Baroreceptor activation therapy A surgical approach to the treatment of hypertension Peter W. de Leeuw and Abraham A. Kroon Key points 1 The sympathetic nervous system plays an important role in blood pressure regulation.

The available data also show that it does not really matter what type of device is used, which site is stimulated, and what the prevailing level of pressure before the stimulation is, even though responses seem somewhat greater under hypertensive conditions. Early experiments in humans Carlsten and colleagues were the first to report on the effects of direct carotid sinus stimulation in humans (22). In five patients with neck cancer who required dissection of the carotid sinus region, they applied brief periods of electrical stimulation using a bipolar electrode.

In addition, Bristow and colleagues were the first to show that the baroreceptor system in patients with hypertension is not only reset, but also less sensitive (11). These investigators measured baroreceptor sensitivity from the relationship between changes in systolic blood pressure and those in the intervals between successive heartbeats after the administration of vasoconstrictor substances. It seems, therefore, that the baroreflex system more or less passively follows the development of hypertension.

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