Baroreflex modulation to gradually decrease blood pressure

• US 20090143838A1
• Filed: 01/27/2009
• Published: 06/04/2009
• Est. Priority Date: 12/24/2003
• Status: Active Grant

• Current Assignee: Imad Libbus, Julio C. Spinelli
• Original Assignee: Imad Libbus, Julio C. Spinelli
• Inventors: Spinelli, Julio C., Libbus, Imad
• Granted Patent: US 8,321,023 B2
• Time in Patent Office: Days
• US Class Current: 607/44
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36146 specified by the stimulation parameters
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

An aspect of the present subject matter relates to a baroreflex stimulator. An embodiment of the stimulator includes a pulse generator to provide a baroreflex stimulation signal through an electrode, and a modulator. The modulator modulates the baroreflex stimulation signal to increase the baroreflex stimulation therapy by a predetermined rate of change to lower systemic blood pressure to a target pressure. Other aspects are provided herein.

Claims

1. A method, comprising:

sensing blood pressure using an implantable medical device; and

progressively lowering blood pressure from a start time to a target end time so that the sensed blood pressure reaches a target blood pressure upon reaching the target end time using a programmed algorithm in the implantable medical device, wherein the target end time and the target blood pressure are programmed into the implantable medical device,

wherein progressively lowering the sensed blood pressure includes delivering neural stimulation that is effective in lowering blood pressure, and using the programmed algorithm to adjust an intensity of the neural stimulation to cause the blood pressure to be progressively lowered so that the sensed blood pressure reaches the target blood pressure near the target end time.

2. The method of claim 1, wherein using the programmed algorithm to increase the intensity of the neural stimulation includes adjusting the neural stimulation as a function of both the difference between the sensed blood pressure and the programmed target pressure, and a time remaining until the target end time.

3. The method of claim 2, further comprising determining cardiac output, wherein using the programmed algorithm to adjust the intensity of the neural stimulation further includes adjusting the neural stimulation as a function of cardiac output.

4. The method of claim 3, wherein determining cardiac output includes directly measuring cardiac output.

5. The method of claim 3, wherein determining cardiac output includes indirectly measuring cardiac output.

6. The method of claim 3, further comprising preventing the blood pressure from causing an unacceptable decrease in cardiac output.

7. The method of claim 1, wherein using the programmed algorithm to adjust the intensity of the neural stimulation includes preventing a central nervous system from adapting to increased neural stimulation.

8. The method of claim 1, wherein using the programmed algorithm to adjust the intensity of the neural stimulation includes adjusting the intensity of the neural stimulation in a manner to improve an ability of a patient to tolerate increased neural stimulation.

9. The method of claim 1, wherein using the programmed algorithm to adjust the intensity of the neural stimulation includes adjusting the intensity of the neural stimulation in a manner to slowly revert a stiffening process caused by hypertension.

10. The method of claim 1, wherein progressively lowering the sensed blood pressure includes progressively lowering the sensed blood pressure to the target pressure over a period of weeks or months.

11. A method, comprising:

sensing blood pressure;

determining cardiac output; and

implementing a programmed algorithm in an implantable medical device to control an intensity of neural stimulation delivered by the implantable medical device to gradually lower blood pressure with time from a start time to an end time to reach a programmed target blood pressure near the end time, wherein the programmed algorithm adjusts the intensity of the neural stimulation as a function of the sensed blood pressure, the programmed target blood pressure, time remaining until reaching the end time, and the cardiac output.

12. The method of claim 11, wherein the programmed algorithm prevents the blood pressure from causing an unacceptable decrease in cardiac output.

13. The method of claim 11, wherein the programmed algorithm initially stimulates to slightly decrease blood pressure, and then gradually increases the intensity of the neural stimulation.

14. The method of claim 11, wherein the programmed algorithm controls the intensity of the neural stimulation to gradually lower blood pressure to reach the programmed target blood pressure over a period of weeks or months.

15. A method for operating an implantable medical device, comprising:

receiving an event trigger to initiate a neural stimulation process performed by the implantable medical device to gradually lower blood pressure;

implementing an algorithm programmed into the implantable medical device to control an intensity of the neural stimulation to gradually lower blood pressure to a target pressure programmed into the implantable medical device, wherein implementing the algorithm to control the intensity of the neural stimulation to gradually lower blood pressure includes initially delivering neural stimulation to slightly lower blood pressure, and then gradually increasing the intensity of the neural stimulation to gradually lower the blood pressure further to the target pressure;

interrupting the algorithm when the neural stimulation reaches the target pressure; and

determining if cardiac output is acceptable and if cardiac output is not acceptable, modifying the algorithm to modify how the blood pressure is gradually lowered.

16. The method of claim 15, further comprising using the implantable medical device to sense parameters, and interrupting the algorithm based on sensed parameters.

17. The method of claim 15, further comprising receiving an event interrupt, and interrupting the algorithm based on receiving the event interrupt.

18. The method of claim 15, wherein implementing the algorithm to control the intensity of the neural stimulation to gradually lower blood pressure to the target pressure includes implementing the algorithm to gradually lower blood pressure to reach the programmed target blood pressure over a period of weeks or months.

19. The method of claim 15, wherein the neural stimulation process performed by the implantable medical device to gradually lower blood pressure includes stimulating a baroreceptor.

20. The method of claim 15, wherein the neural stimulation process performed by the implantable medical device to gradually lower blood pressure includes stimulating an afferent nerve.