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Increased activity of the sympathoadrenal system plays a major role in the pathogenesis of essential hypertension and end organ damage.1,2 Recent effective antihypertensive strategies have manipulated autonomic nervous control mechanisms including renal nerve ablation.1 Here, we present the first patient in whom refractory hypertension was controlled chronically with deep brain stimulation (DBS) of the ventrolateral periaqueductal gray (PAG)/periventricular gray (PVG) as a primary response and not secondary to associated pathologic changes.
Level of evidence.
This study provides Class IV evidence that chronic electrical stimulation of the PAG/PVG may provide effective treatment for controlling blood pressure in patients with drug-resistant hypertension.
Case report.
A 55-year-old man developed left-sided weakness, and an ischemic stroke affecting the internal capsule was diagnosed (figure e-1A on the Neurology® Web site at www.neurology.org). At hospital admission, hypertension and hypercholesterolemia were diagnosed. In the peristroke period, blood pressure readings ranged from 265/96 to 153/89 mm Hg, and antihypertensive medication was prescribed: atenolol (50 mg), diltiazem (240 mg), perindopril (4 mg), and indapamide (1.25 mg). Aspirin (75 mg) and simvastatin (40 mg) were also prescribed. This medication regimen maintained his blood pressure at 145/69 mm Hg. Four months later, subsequent to multiple dose increases in the quadruple therapy, his blood pressure ranged from 153/87 to 134/72 mm Hg. Unfortunately, although his hemiplegia resolved, he developed a severe left-sided hemibody central pain syndrome that proved refractory to treatment over the following 3 years, leading to referral for DBS to treat his pain.
With use of established protocols3 and a MRI-guided stereotactic technique, the PAG/PVG region was …
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