High blood pressure, also called hypertension, is one of the biggest health problems in the world. Millions of people live with it every day, and many do not even realize they have it because it often causes no obvious symptoms at first.
Over time, however, high blood pressure can quietly damage the body and greatly increase the risk of heart attacks, strokes, heart failure, kidney disease, and early death.
Doctors usually treat high blood pressure with medications that relax blood vessels, reduce fluid levels, or slow the heart down. While these medicines help many people, some patients continue to have dangerously high blood pressure even after taking several drugs. This condition is known as resistant hypertension.
Now, scientists from the University of Bristol in the United Kingdom believe they may have discovered a completely new way to treat this difficult condition. Surprisingly, their research focuses on a tiny organ in the neck that is only about the size of a grain of rice.
This tiny structure is called the carotid body. It sits near two major arteries that carry blood from the heart to the brain. Although very small, the carotid body plays an important role in monitoring oxygen levels in the blood.
The study was published in the journal JACC: Basic to Translational Science and was led by Professor Julian Paton and Dr. Angus Nightingale.
The researchers carried out a clinical trial involving people with resistant high blood pressure. Their treatment approach was unusual. Instead of giving patients another medicine, surgeons removed one of the two carotid bodies.
The results surprised the research team. Blood pressure levels dropped immediately after the procedure and stayed lower over time.
Dr. Nightingale explained that the improvements were even greater than what doctors often see with standard blood pressure medications. This finding suggests that the carotid body may play a major role in causing high blood pressure in some patients.
So what exactly does the carotid body do? Scientists describe it as a built-in sensor that constantly checks how much oxygen is present in the blood. If oxygen levels fall too low, the carotid body sends signals to the brain. The brain then tells the body to breathe faster and raise blood pressure so more oxygen can reach important organs.
This system is very useful during emergencies or low-oxygen situations. However, in some people, the carotid body appears to become overactive. Instead of only responding when necessary, it keeps sending alarm signals that push blood pressure higher all the time.
Professor Paton compared the problem to a thermostat that is stuck on a high setting. Even when the body does not need extra pressure, the system continues trying to increase it.
The researchers believe this may explain why some people struggle to control their blood pressure even with multiple medications.
Another important part of the study involved identifying which patients were most likely to benefit from treatment targeting the carotid body. The team developed special tests that could detect signs of carotid body overactivity.
Patients who reacted strongly to small drops in oxygen levels and who naturally breathed more at rest appeared to have the most overactive carotid bodies. These patients also experienced the biggest drops in blood pressure after surgery.
This means doctors may eventually be able to offer more personalized treatment instead of using the same approach for everyone.
High blood pressure remains a huge burden worldwide. It is one of the leading causes of strokes, heart disease, and kidney failure. In the United Kingdom alone, hypertension costs the healthcare system billions of pounds each year.
Although the surgery showed promising results, the researchers do not believe removing the carotid body will become a routine treatment for most patients. Surgery carries risks, and not everyone with high blood pressure would need such a procedure.
Instead, the scientists hope to develop medicines that can calm down an overactive carotid body without surgery.
Their research team may already be making progress toward this goal. In another study involving animals, they discovered that a molecule called ATP, short for adenosine triphosphate, helps control activity inside the carotid body.
The scientists also identified a receptor called P2X3 that responds to ATP. By blocking this receptor, they were able to reduce the excessive alarm signals coming from the carotid body without completely shutting the system down.
This discovery could eventually lead to a completely new type of blood pressure treatment. Researchers say it may become the first major new approach to treating hypertension in more than 15 years.
The work took nearly a decade of collaboration between researchers and hospitals across the United Kingdom, Poland, the United States, Brazil, and New Zealand. It was supported by the British Heart Foundation.
Scientists say the findings bring them closer to creating more personalized and effective treatments for high blood pressure by targeting one of the smallest organs in the body.
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The study is published in JACC: Basic to Translational Science.
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