Hypertension diagnosis and therapy using pressure sensor

• US 8,027,724 B2
• Filed: 08/03/2007
• Issued: 09/27/2011
• Est. Priority Date: 08/03/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhang, Cheng, Arcot-Krishnamurthy, Shantha, Wei, Xuan, Li, Dan
• Primary Examiner(s): Schaetzle; Kennedy J
• Assistant Examiner(s): LEE, ERICA SHENGKAI
• Application Number:
  US11/833,435
• Publication Number:
  US 20090036940A1
• Time in Patent Office: 1,516 Days
• Field of Search: 607 17- 19, 607/23, 607/30, 607/32, 607/44, 607/60, 607/62, 600485-505
• US Class Current: 607/23
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• 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 1/36564 controlled by blood pressure

Abstract

An example relates to a method for sensing a pulmonary artery pressure (PAP) and providing a sensed PAP signal, detecting an abnormal blood pressure (BP) condition using information from the sensed PAP signal, delivering a pacing energy to a heart, and automatically altering at least one pacing characteristic in response to the detected abnormal BP condition. The detecting an abnormal BP condition can include detecting various forms of hypertension or hypotension. The automatically altering the at least one pacing characteristic can include automatically altering at least one of a pacing rate, a pacing waveform, an atriventricular (AV) delay, an interventricular (VV) delay, a pacing mode, or a pacing site. The method can also include delivering vagal nerve stimulation and automatically altering the vagal nerve stimulation in response to the detected abnormal BP condition. The detecting the abnormal BP condition can also include using a sensed auxiliary physiological parameter.

Claims

1. A system comprising:

an implantable pulmonary artery (PA) pressure sensor configured to sense a pulmonary artery pressure (PAP) of a PA and provide a sensed PAP signal of a patient;

a diagnostic circuit configured to detect an abnormal blood pressure (BP) condition providing a differential indication of non-sleep vs. sleep hypertension by;

determining a sleep interval using at least one of (1) time-of-day information or (2) patient status information indicating whether the patient is sleeping;

determining a sleep BP using information from at least a portion of the sensed PAP signal during the sleep interval;

determining a non-sleep BP using information from at least a portion of the sensed PAP signal outside of the sleep interval;

determining the differential indication of non-sleep vs. sleep hypertension by comparing information about the sleep BP to information about the non-sleep BP; and

an implantable pulse generator (PG) configured to deliver a pacing energy to a heart and automatically alter at least one pacing characteristic in response to the detected abnormal BP condition providing the differential indication of non-sleep vs. sleep hypertension.

2. The system of claim 1, wherein the PA pressure sensor is configured to be fixed to a location within the PA.

3. The system of claim 1, wherein the abnormal BP condition includes hypertension, including at least one of chronic hypertension, transient hypertension, systolic hypertension, or diastolic hypertension.

4. The system of claim 1, wherein the abnormal BP condition provides the differential indication of non-sleep vs. sleep hypertension by providing an indication of nocturnal hypertension.

5. The system of claim 1, wherein the at least one pacing characteristic includes at least one of a pacing rate, a pacing waveform, an atrioventricular (AV) delay, an interventricular (VV) delay, a pacing mode, or a pacing site.

6. The system of claim 1, wherein the PG is further configured to deliver vagal nerve stimulation and automatically alter the vagal nerve stimulation in response to the detected abnormal BP condition.

7. The system of claim 1, wherein the PG includes the diagnostic circuit.

8. The system of claim 1, wherein the diagnostic circuit includes an external programmer and the PG is configured to wirelessly communicate with the external programmer.

9. The system of claim 1, including:

a PAP signal conditioning circuit configured to condition the sensed PAP signal into a conditioned PAP signal; and

a communication circuit configured to transmit the conditioned PAP signal to the PG.

10. The system of claim 9, wherein the communication circuit includes an ultrasonic transducer configured to acoustically transmit the conditioned PAP signal to the PG and the PAP signal conditioning circuit is configured to condition the sensed PAP signal for the acoustic transmission.

11. The system of claim 1, wherein the PG includes a radio frequency (RF) communication circuit and the diagnostic circuit is configured to communicate to the PG using an RF communication link.

12. The system of claim 1, including:

an auxiliary physiological sensor configured to sense an auxiliary physiological parameter different than the PAP and provide a sensed auxiliary physiological signal; and

wherein the diagnostic circuit is configured to detect an abnormal BP condition using information from the sensed PAP signal and information from the sensed auxiliary physiological signal.

13. The system of claim 12, wherein the auxiliary physiological sensor includes a cardiac sensor, configured to sense a cardiac signal as the auxiliary physiological parameter.

14. The system of claim 13, wherein the cardiac sensor includes a heart rate (HR) detector, configured to sense a HR;

and

wherein the diagnostic circuit is configured to determine a relationship between the information from the sensed PAP signal and the sensed HR signal, and the abnormal BP condition includes an unstable BP-HR control loop.

15. The system of claim 12, wherein the auxiliary physiological sensor includes at least one of an activity sensor, a posture sensor, or a respiration sensor.

16. The system of claim 1, wherein the abnormal BP condition provides the differential indication of non-sleep vs. sleep hypertension by providing an indication of non-sleep hypertension.

17. The system of claim 1, wherein the abnormal BP condition provides the differential indication of non-sleep vs. sleep hypertension by comparing information about the sleep BP to information about the non-sleep BP using a threshold, and wherein the differential indication of non-sleep vs. sleep hypertension provides an indication of sleep hypertension when the non-sleep BP fails to exceed the sleep BP by a specified threshold amount.

18. A method comprising:

sensing a pulmonary artery pressure (PAP) and providing a sensed PAP signal;

determining an abnormal blood pressure (BP) condition using information from the sensed PAP signal including;

determining a sleep interval using at least one of (1) time-of-day information or (2) patient status information indicating whether the patient is sleeping;

determining a sleep BP using information from at least a portion of the sensed PAP signal during the sleep interval;

determining a non-sleep BP using information from at least a portion of the sensed PAP signal outside of the sleep interval; and

determining a differential indication of non-sleep vs. sleep hypertension by comparing information about the sleep BP to information about the non-sleep BP;

delivering pacing energy to a heart; and

automatically altering at least one pacing characteristic in response to the detected abnormal BP condition.

19. The method of claim 18, wherein the sensing includes using an implantable pulmonary artery (PA) pressure sensor configured to be fixed to a location within a PA.

20. The method of claim 18, wherein the detecting the abnormal BP condition includes detecting hypertension, including detecting at least one of chronic hypertension, transient hypertension, systolic hypertension, or diastolic hypertension.

21. The method of claim 18, wherein the detecting the abnormal BP condition includes determining the differential indication of non-sleep vs. sleep hypertension to provide an indication of nocturnal hypertension.

22. The method of claim 18, wherein the detecting the abnormal BP condition includes determining the differential indication of non-sleep vs. sleep hypertension to provide an indication of awake hypertension.

23. The method of claim 18, wherein the automatically altering the at least one pacing characteristic includes automatically altering at least one of a pacing rate, a pacing waveform, an atrioventricular (AV) delay, an interventricular (VV) delay, a pacing mode, or a pacing site.

24. The method of claim 18, including:

delivering vagal nerve stimulation; and

automatically altering the vagal nerve stimulation in response to the detected abnormal BP condition.

25. The method of claim 18, wherein the detecting the abnormal BP condition includes using a diagnostic circuit, the method further including:

conditioning the sensed PAP signal into a conditioned PAP signal for transmission to the diagnostic circuit; and

transmitting the conditioned PAP signal to the diagnostic circuit.

26. The method of claim 25, wherein the using the diagnostic circuit includes using an ultrasonic transducer, the conditioning the sensed PAP signal for transmission includes conditioning the PAP signal for acoustic transmission, and the transmitting the conditioned PAP signal includes acoustically transmitting the conditioned PAP signal.

27. The method of claim 18, including:

sensing an auxiliary physiological parameter different than the PAP and providing a sensed auxiliary physiological signal; and

wherein the detecting the abnormal BP condition includes using information from the sensed PAP signal and information from the sensed auxiliary physiological signal.

28. The method of claim 27, wherein the sensing the auxiliary physiological parameter includes sensing a cardiac signal.

29. The method of claim 28, wherein the sensing the cardiac signal includes sensing a heart rate (HR);

the method further including determining a relationship between the sensed PAP information and the sensed HR, wherein the detecting the abnormal BP condition includes detecting an unstable BP-HR control loop.

30. The method of claim 27, wherein the sensing the auxiliary physiological signal includes sensing at least one of an activity signal, a posture signal, or a respiration signal.

31. A system comprising:

an implantable pulmonary artery (PA) pressure sensor configured to sense a pulmonary artery pressure (PAP) of a PA of a subject and to provide a sensed PAP signal;

a PAP signal conditioning circuit configured to condition the sensed PAP signal into a conditioned PAP signal for acoustic transmission;

a communication circuit including an ultrasonic transducer configured to acoustically transmit the conditioned PAP signal to an implantable pulse generator (PG);

an external diagnostic circuit including a radio frequency (RF) communication circuit configured to receive the conditioned PAP signal from the implantable PG, wherein the external diagnostic circuit is configured to detect an abnormal blood pressure (BP) condition including a differential indication of non-sleep vs. sleep hypertension using;

a determination of a sleep interval using at least one of (1) time-of-day information or (2) patient status information indicating whether the patient is sleeping;

information from at least a portion of the conditioned PAP signal during the sleep interval, including a sleep BP;

information from at least a portion of the conditioned PAP signal during the non-sleep interval, including a non-sleep BP; and

a threshold;

wherein the external diagnostic circuit is configured to detect the differential indication of non-sleep vs. sleep hypertension if the non-sleep BP fails to exceed the sleep BP by at least the threshold; and

wherein the implantable PG includes an ultrasonic transducer configured to receive the conditioned PAP signal from the communication circuit and an RF communication circuit configured to transmit the conditioned PAP signal to the external diagnostic circuit, wherein the implantable PG is configured to deliver a pacing energy to a heart and to automatically alter at least one pacing characteristic in response to the detected abnormal BP condition.