RECIPIENT:  Dr. Jill Goldstein

TITLE: Development of an electroceutical for treatment of comorbidity between hypertension and major depression.
INSTITUTION: Brigham and Women’s Hospital
DESCRIPTION:  Hypertension is a leading cause of morbidity and mortality in the United States with an overall prevalence of approximately 29%, corresponding to 70 million of Americans. Despite the benefits of existing blood pressure lowering drugs, 50% of hypertensive patients are inadequately controlled while taking medication and reduction in cardiovascular disease (CVD) incidence remains an important goal.

A chronic withdrawal of vagal tone has been involved in treatment-resistance, structural cardiac remodeling and progression to CVD in hypertensive subjects, suggesting this marker as a potential novel therapeutic target. Hypertension is also frequently associated with major depression, with an estimated comorbidity of 22%. Patients with hypertension and comorbid depression are particularly prone to present cardiac vagal dysregulation, and have an increased risk for the development of CVD.

Furthermore, this particular group of patients represents a challenge to physicians and healthcare providers who are unable to reach blood pressure target reductions with available antihypertensive medications, and need to consider cardiac adverse events and complicated cardiovascular prognosis with the use of some antidepressants.

Hypertensive patients, and in particular those with comorbid depression, could greatly benefit from an intervention oriented to regulate vagal activity, with subsequent effects in blood pressure and cardiovascular risk reduction. Given preliminary work from our group, we are proposing the development and validation of an enhanced transcutaneous vagus nerve stimulation system by gating the stimulation to specific variations in respiratory and cardiac activity, which will optimize its effects in blood pressure reduction and cardiovascular autonomic modulation in hypertensive patients with comorbid depression.