Experimental implant helps Lincoln man
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By MARK ANDERSEN / Lincoln Journal Star
Brian Motschenbacher spent his days waiting for an artery to blow.
His upper blood pressure number of 250 was double the healthy norm of 120.
Mortality grows geometrically for every 20 points over normal. At 140 it’s double. At 160 it’s quadruple.
Related Media
Blood pressure control implant
An experimental implant helped lower the blood pressure that put a Lincoln man at 96 times as likely to suffer a fatal heart attack....
The Nebraska Heart Hospital is recruiting subjects for an experimental surgical implant designed to reduce blood pressure in people with dangerously uncontrolled primary hypertension.
To qualify, patients must have readings higher than 160/90, take at least three blood pressure medications and have no carotid blockages. The study excludes people with chronic atrial fibrillation, those undergoing dialysis, those with certain nerve disorders and those who have undergone prior neck surgery or radiation. All costs are covered.
Call (866) 447-8533 or visit www.rheosstudy.com.
At 250, the 40-year-old Air Force retiree and father of two from Lincoln had 96 times the normal reason to fear death.
And it had come out of the blue, said his wife, Shawnie, seated beside him recently at Nebraska Heart Institute Heart Hospital.
One night Brian was grilling in the backyard when a nosebleed sent him to the emergency room. Months later he’s at the Mayo Clinic, learning there’s no medical explanation for his high blood pressure and little anyone can do.
After Mayo, Shawnie said, “I thought we were done.”
Brian spent his weary days on a couch fighting headaches.
“Even just going up stairs, I felt I’d aged 40 years,” he said.
He was frustrated. He’s a strong-willed, get-’er-done kind of guy, Shawnie said, and nobody could fix it. The entire family suffered.
“He was not the same man I married,” she said. “Every day, I wondered when that stroke was going to happen.”
Heavy doses of five drugs lowered Brian’s upper pressure to 190 — dropping the mortality odds to 12 times normal. The drugs gave him heartburn and he slept poorly.
So when Lincoln heart surgeon Deepak Gangahar suggested an experimental implant that might trick his brain into lowering the pressure, Brian figured he had little to lose.
Gangahar did the surgery in March 2007 at Nebraska Heart Hospital, wrapping the carotid arteries on both sides of Brian’s neck with electrical leads. He placed other leads in Brian’s chest and connected all to a power pack under the skin.
Gangahar switched it on and looked up at the pressure monitor.
An estimated 72 million Americans, or roughly one in every four people, have high blood pressure.
It’s a major killer, blamed for an estimated one in eight deaths worldwide. It’s a star player in heart attacks, strokes, heart failure, kidney failure, peripheral vascular disease and erectile dysfunction.
In maybe a third of all cases, Gangahar said, high blood pressure, called hypertension, is a secondary symptom of problems with the kidneys, thyroid, adrenal glands.
But in the majority of cases, he said, it’s unexplained. There’s a reason, but science hasn’t found it.
Reduce the pressure with medications, Gangahar said, and the risks decline. Physicians have a large candy dish worth of different drugs to try. It’s common for people to take small handfuls of them.
But for one-fourth of everyone with high blood pressure, Gangahar said, the drugs don’t do enough.
He didn’t offer the prevalence of people with crazy high, inexplicable, uncontrolled hypertension like Brian’s, commenting, “There’s a lot.”
People don’t hear about it, he said, because there hasn’t been any treatment to offer.
For more than 50 years, Gangahar said, heart researchers have toyed with tricking the body’s natural blood pressure control system out of early retirement.
Normally, pressure monitors in the neck and chest, called baroreceptors, trigger signals to the brain. The brain relaxes arteries while also suppressing heart and kidney function to drop blood pressure.
A few years ago, Gangahar said, researchers in Minnesota created a practical device that stimulates the baroreceptors electrically.
It’s experimental and unproven, Gangahar stressed. An FDA pivotal trial of 300 cases is under way to determine its effectiveness, but initial results have been encouraging.
According to device maker CVRx, the Rheos Baroreflex Hypertension Therapy system decreased upper blood pressure an average of 39 points in one group over a year.
If the device proves it saves and improves lives, Gangahar said, he foresees it following in the wake of pacemakers, becoming commonplace, steadily getting better.
For now, there are drawbacks.
Researchers are working to develop minimally invasive techniques for placing the leads. “Currently, it’s a major operation under general anesthesia,” Gangahar said.
Also, the existing power pack lasts one to two years before it must be replaced.
It was a battery check that brought the Motschenbachers back to Nebraska Heart Hospital recently.
Before the device, Brian said, he’d figured his was a lost cause.
“If I would have made it to 50, I would have been impressed.”
His wife doubted he’d make it to 45. “It saved his life and our marriage,” she said, choking a sob.
When they had last come in for a checkup two months earlier, Brian’s readings were 125/82. He takes low doses of just three medications and has returned to normal activities.
The change was immediate.
Just after surgery, in his hospital room, Shawnie said, she’s staring at his blood pressure figures, “And I’m a sobbing mess. I saw what this could do.”
Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.
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Gary and Sharon Alban wrote on March 25, 2008 5:40 pm: