THE PATIENT
Back in 2014, I felt tired and unwell for several months with flu-like symptoms, a headache and aching limbs.
Around this time, I also discovered I had high blood pressure (although the two were related, I didn’t know this at the time).
My GP prescribed ACE inhibitors and beta blockers and I didn’t think much more of it. But it all came to a head in December when I suddenly collapsed.
My sister took me to AE where they told me I’d had a mild heart attack.
My heart was racing and my blood pressure was dangerously high. I was put on a drip, but it was still high the next day, so I was taken to the London Chest Hospital by ambulance.
Claire
It seems the high blood pressure was causing my heart to work harder, which was weakening it — this was why I’d had the heart attack.
At its worst, my reading blood pressure was 240/130 (a normal reading is about 120/80). They didn’t know why this was happening to me — I wasn’t overweight and didn’t smoke or drink.
I had to stay in hospital for two weeks having lots of tests and trying different combinations of medicines.
But my readings were still high, so the doctors said they couldn’t discharge me as I was at risk of a more serious heart attack.
Over the next two months I was sent to two other hospitals to see if they could help.
All the time I was terrified about having a stroke or heart attack, and it was awful being away from my children — Matthew, 16, and Katie, 14 — and my husband Graham.
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I was only allowed home towards the end of February because there was nothing else they could do.
After that, I went to a specialist clinic at Barts Hospital once a week. But I was otherwise practically housebound because the doctors said I should not exert myself, physically or emotionally.
Even though it’s early days since the operation, Claire’s blood pressure has dropped to 146/104
I often felt completely drained and breathless and had severe headaches and chest pains.
I felt too exhausted to do the things I used to love, such as playing and coaching football and walking the dog.
Then about six months ago, Dr Mel Lobo, the director of the clinic, asked if I wanted to try something new.
His hospital was to be one of the first in the country to give patients like me a special new implant called the Barostim neo — a bit like a pacemaker — which would hopefully control my blood pressure in a way that drugs couldn’t.
Apparently, it would override my body’s blood pressure system, which wasn’t working properly. On June 30, I had the implant put in at the Royal London Hospital.
I woke up from the operation with some pain around my collarbone – near where they had gone in to fit the device — but I expected that.
Even though it’s early days since the operation, I feel a bit better already and my blood pressure has dropped to 146/104.
If I am able to get even a quarter of my life back then I will consider it a success.
THE SPECIALIST
Dr Mel Lobo is director of the Barts Blood Pressure Clinic at Barts Health NHS Trust.
Blood pressure is the amount of pressure in the arteries. It’s what drives blood from the heart to the major organs.
But in people with hypertension, or high blood pressure, the heart has to work harder to pump blood, which ultimately weakens it.
The increased pressure also damages artery walls, which can result in a haemorrhage or blockage, potentially causing a stroke, heart attack or kidney failure.
High blood pressure doesn’t necessarily cause symptoms, but some patients experience severe headaches, nausea, dizziness, drowsiness, blurred vision, nosebleeds, an irregular heartbeat or breathlessness.
High blood pressure doesn’t necessarily cause symptoms, but some patients experience severe headaches, nausea, dizziness, drowsiness, blurred vision, nosebleeds, an irregular heartbeat or breathlessness
At first, patients are encouraged to adopt lifestyle changes, such as cutting back on alcohol and salt intake and taking more exercise.
If this doesn’t work, they usually need to take medication for the rest of their life — such as ACE inhibitors, which relax blood vessels, and beta-blockers, which make the heart beat more slowly.
They may also take calcium channel blockers to widen the arteries, and diuretics, which flush out excess water and salt from the body, which also helps relax the blood vessel walls.
But there are numerous potential side-effects, including severe lethargy, headaches, dizziness and impotence.
And in about half a million people in the UK with high blood pressure, for reasons that are not yet clear, medication fails to control it — this is known as resistant hypertension.
Now we have an implant, called Barostim neo, that may help.
Widely used in Germany, but new to the UK, it uses electrical pulses to override the body’s natural blood pressure system, which, for some reason, is faulty in these patients.
This new pacemaker uses electrical pulses to override the body’s natural blood pressure system, which, for some reason, is faulty in these patients
It specifically works on the baroreceptors — these are blood pressure sensors in the carotid arteries in the neck.
In a healthy person, they sense and measure blood flow to the brain. They then send signals to the brain, which then adjusts blood pressure accordingly by triggering blood vessels to relax or contract as necessary. In people with uncontrolled high blood pressure, these baroreceptors don’t work properly.
The device stimulates these receptors with electrical pulses, overriding the faulty signals and sending the correct ones so that blood pressure is better controlled.
This method is also tailored to the individual patient. Doctors programme it remotely, adjusting the frequency and strength of the pulses according to how severe the problem is.
The pulses also differ depending on the time of day, so that blood pressure is higher in the day and lower during sleep.
The system consists of a battery-powered generator box (a little bigger than a matchbox) and lead with an electrode on the end, about the size of a £2 coin.
Th minor procedure involves inserting this battery-powered generator box in a pocket under the collarbone
With the patient under general anaesthetic, we start by making a 5cm incision in the skin under the collarbone, creating a small pocket for the generator, which is implanted in the chest rather like a pacemaker.
During the same operation, we make a 3cm incision in the neck to access the carotid artery, then we tunnel under the skin and stitch the electrode to the carotid artery.
The procedure takes about an hour, and patients who have had the procedure in Germany are typically discharged the next day.
The battery will probably need replacing after three to six years.
Patients are followed up carefully, with ultrasound scans to check the device is in the right place and blood pressure monitoring. After her operation, Claire’s blood pressure immediately dropped by 10 per cent, which was very promising. Based on the German experience, it should continue to drop.
In a European trial of 30 patients with resistant hypertension, the device reduced their blood pressure and there were no side-effects.
So far the Barostim Neo is available only on a case-by-case basis, but we hope to be able to start clinical trials of it soon.
My hope is that the treatment will lead to a dramatic reduction in the very dangerous risks these patients live with every day, and free them from the hugerestrictions that arise from uncontrollable hypertension.
The operation costs around £22,000 to the NHS. Patients interested in the device should ask their GP for a referral to Barts Health NHS Trust Blood Pressure Clinic.