28 February 2017
Brain stimulation used in world-first blood pressure treatment at North Bristol Trust
North Bristol Trust have released the following story today
which can also be seen on their
A patient has become the first in the world to have deep brain
stimulation to reduce her blood pressure in a procedure carried out
by one of our consultants.
Neurosurgeon Nik Patel worked with colleagues at the University
of Bristol and University Hospitals Bristol NHS Foundation Trust on
the case, which dramatically reduced the woman's high blood
pressure. The work has now been published in the journal
Amely Hoffmann's blood pressure was extremely high and all other
drugs and devices had failed to reduce it.
She had suffered high blood pressure for ten years, which was
causing exhaustion and migraines, and was taking eight different
antihypertensive drugs, which were also causing side effects.
Mrs Hoffmann said: "Despite countless
tests and check-ups, no one seemed to be able to find the
"The doctors also put a lot of effort into finding a proper
medication for me to bring down the blood pressure.
"I was suffering from very intense headaches and endured a
sudden deafness / hearing loss eight times. They resulted in a
complete deafness of the right ear and a severe hearing loss of the
"I was afraid what the future might bring and I was worried for
After a chance discovery online Mrs Hoffmann got in touch with
Mr Patel to see if he could help her.
In 2011 the consultant neurosurgeon had
published details of a previous case where deep brain
stimulation (DBS) had been used for neuropathic pain but the
procedure had also resolved his hypertension (high blood
DBS is an established neurological procedure that involves
inserting an electrode - a thin insulated wire - into the brain,
which is connected to a device similar to a pacemaker that
stimulates a specific area of the brain.
It is typically used in patients with Parkinson's and those with
intractable pain and we use a state-of-the-art robot to carry out
the procedure at Southmead Hospital.
By targeting the periaqueductal grey (PAG) region of the brain
to control severe pain Mr Patel had discovered the impact it could
have on blood pressure.
Mrs Hoffmann became the first known person in the world to have
elective DBS for a cardiovascular disease in July 2013 at Frenchay
Hospital as part of a research trial.
When she first visited Consultant Cardiologist Dr Angus
Nightingale at the Bristol Heart Institute from her home in
Germany, Mrs Hoffmann's blood pressure was 320/150 mmHg. Normal
blood pressure is 120/80 mmHg mmHg and a patient with severe
hypertension would typically have blood pressure of 180/90 mmHg
Dr Nightingale said it was the highest blood pressure he had
"We checked this several times to make sure it was real," he
"It's amazing that her body has survived with such a high blood
pressure. We were worried that she could have a stroke at any
Following the DBS procedure Mrs Hoffmann's blood pressure
dropped 100 - 150 mmHg and she was able to stop taking seven of the
eight drugs she had previously needed.
Two and-a-half years after the DBS the effect has been sustained
and Mrs Hoffmann's blood pressure ranges between 180 - 220/130 mmHg
and her quality of life has improved.
"The incredible difference the DBS made was obvious immediately
after the surgery," Mrs Hoffmann said.
"The device was not even switched on, but placing the electrode
in my brain and the resulting swelling alone brought down my blood
pressure by about 150 mmHg. I didn't have to take any of my blood
pressure lowering drugs anymore, except for one which you need to
stop taking gradually."
High blood pressure can lead to heart failure, renal failure and
stroke and up to 15 per cent of people with hypertension do not
respond to the current drug therapies or devices available.
Mr Patel said: "We are impressed by these encouraging findings,
which may hold promise for a substantially large population of
patients with drug-resistant hypertension, who otherwise remain at
risk of suffering strokes and cardiovascular disease
"High blood pressure has the biggest burden on human health
"We need to broaden this study to see whether it genuinely could
be a possible treatment for this group of patients, but we are
Professor of Translational Cardiovascular Science at
the University of Bristol Julian Paton said: "We've long known from
animal models that stimulation of the PAG can regulate blood
pressure and as such DBS within the PAG offers a new opportunity to
control blood pressure in patients with resistant
Studies funded by the British Heart Foundation and performed by
Dr Erin O'Callaghan and Dr Emma Hart from the University of Bristol
found that DBS reduced the activity of nerves regulating blood
pressure by 40%.
Dr O'Callaghan said: "This confirms that DBS is an effective way
of reducing the pathological activity of these nerves and thereby
decreasing blood pressure. Current drugs do not provide
effective long term reduction in the activity of these blood
pressure nerves - DBS appears to."
A small trial is planned to test the efficacy of DBS as a
treatment option for drug-resistant hypertensive patients.
This work has been carried out with the support of the
Severnside Alliance for Translational Research (SARTRE), North
Bristol NHS Trust, University Hospitals Bristol NHS Foundation
Trust, The University of Bristol and the British Heart
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