Methods and Systems for Controlling Blood Pressure

• US 20170304048A1
• Filed: 04/20/2017
• Published: 10/26/2017
• Est. Priority Date: 04/22/2016
• Status: Active Grant

• Current Assignee: Backbeat Medical, LLC
• Original Assignee: Backbeat Medical, Inc.
• Inventors: Mika, Yuval, Sherman, Darren, Schwartz, Robert S., Van Tassel, Robert A., Burkhoff, Daniel
• Granted Patent: US 10,485,658 B2
• Time in Patent Office: Days
• CPC Class Codes: A61F 2/2403 with pivoting rigid closure members check valves with hinged closure members in general F16K15/03
• CPC Class Codes: A61F 2/2409 Support rings therefor, e.g. for connecting valves to tissue annuloplasty rings A61F2/2442
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36528 the parameter being measured by means of ultrasound
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay

Abstract

Systems and methods for controlling blood pressure via electrical stimulation of the heart are disclosed. Embodiments may include at least two different stimulation patterns, each configured to reduce blood pressure to a different degree, and may alternate between stimulation patterns based on the need of a patient, for example, alternating between day and night or between periods of strenuous and light activity. Some embodiments may take advantage of a slow baroreflex response that occurs after treatment is stopped, suspending treatment for extended periods, and then resuming treatment before blood pressure levels reach pretreatment values. Embodiments may control blood pressure by controlling atrial pressure and atrial stretch.

Claims

1. A system for reducing blood pressure in a patient, the system comprising:

a stimulation circuit configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of the patient; and

at least one controller configured to execute the delivery of one or more stimulation patterns of stimulation pulses to the at least one cardiac chamber over a time interval,

wherein a first stimulation pattern of the one or more stimulation patterns reduces the blood pressure of the patient by a first reduction amount,

wherein a second stimulation pattern of the one or more stimulation patterns reduces the blood pressure of the patient by a second reduction amount,

wherein the first reduction amount is greater than the second reduction amount, and

wherein the second reduction amount is greater than zero.

2. The system of claim 1, wherein the first stimulation pattern and the second stimulation pattern are delivered in correlation with a variation in the patient'"'"'s blood pressure that is not a result of stimulation.

3. The system of claim 2, further comprising a blood pressure sensor configured to sense the patient'"'"'s blood pressure.

4. The system of claim 1, wherein the time interval is a 24-hour period, and wherein the first stimulation pattern and the second stimulation pattern are delivered based on the need of the patient during the 24-hour period.

5. The system of claim 4, wherein the first stimulation pattern is delivered during at least part of the day and the second stimulation pattern is delivered during at least part of the night.

6. The system of claim 4, wherein the first stimulation pattern is delivered during a period of a first level of activity by the patient and the second stimulation pattern is delivered during a period of a second level of activity by the patient, and wherein the first level is lower than the second level.

7. The system of claim 1, wherein the first stimulation pattern provides a first atrioventricular delay and the second stimulation pattern provides a second atrioventricular delay, and wherein the first atrioventricular delay is shorter than the second atrioventricular delay.

8. The system of claim 1, wherein at least one of the stimulation pulses stimulates the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced, and

wherein the one or more stimulation patterns comprise stimulating the heart such that atrial kick is reduced or prevented.

9. The system of claim 8, wherein the higher atrial pressure is transient and does not result in chronic increase of atrial pressure.

10. The system of claim 1, wherein the first stimulation pattern and the second stimulation pattern are both configured to reduce or prevent atrial kick.

11. The system of claim 1, wherein the at least one controller is configured to execute the delivery of a third stimulation pattern of stimulation pulses to the at least one cardiac chamber over the time interval, and wherein the third stimulation pattern is different from the first stimulation pattern and the second stimulation pattern.

12. A method, carried out with an implanted heart muscle stimulator associated with a heart of a patient, for reducing blood pressure of the patient, the method comprising:

delivering, for at least a plurality of days, to at least one cardiac chamber of a heart of the patient a treatment stimulation pattern that reduces the blood pressure of the patient by a first reduction amount; and

discontinuing delivery of the first treatment stimulation pattern and delivering, for at least a plurality of days, to the at least one cardiac chamber of the heart a resting stimulation pattern providing a lesser amount of blood pressure reduction than the first reduction amount.

13. The method of claim 12, wherein the treatment stimulation pattern is delivered for at least one week and the resting stimulation pattern is delivered for at least one week.

14. The method of claim 12, wherein the duration of the treatment stimulation pattern and the duration of the resting stimulation pattern are different.

15. The method of claim 14, wherein the duration of the resting stimulation pattern is shorter than the duration of the treatment stimulation pattern.

16. The method of claim 15, wherein the duration of the resting stimulation pattern is within a range of approximately 50% to approximately 80% of the duration of the treatment stimulation pattern.

17. The method of claim 12, wherein the treatment stimulation pattern comprises a plurality of stimulation patterns, and wherein at least some of the plurality of stimulation patterns include one or more atrial kick reducing pulse settings.

18. The method of claim 17, wherein the one or more atrial kick reducing settings vary based on need.

19. The method of claim 12, wherein the resting stimulation pattern comprises one of no application of pacing;

pacing without atrial kick reduction; and

pacing with a smaller atrial kick reduction than the treatment stimulation pattern.

20. A method for delivering a blood pressure reducing electrical stimulation to a heart of a patient, the method comprising:

pacing a first chamber of the heart and, after a first delay, pacing a second chamber of the heart to obtain a desired blood pressure change;

sensing a first intrinsic excitation of the first chamber and, after a second delay, pacing the second chamber;

determining a first blood pressure change resulting from the second delay;

comparing the first blood pressure change to the desired blood pressure change;

adjusting the second delay to a third delay intended to adjust the first blood pressure change closer to the desired blood pressure change;

sensing a second intrinsic excitation of the first chamber and, after the third delay, pacing the second chamber;

determining a second blood pressure change resulting from the third delay;

determining that the second blood pressure change is substantially equal to the desired blood pressure change; and

delivering stimulation patterns to the heart that comprise pulses having the third delay between sensing intrinsic excitation of the first chamber and delivering a stimulation pulse to the second chamber.