Novel Setup Algorithm for Cardiac Neuromodulation Therapy

Inclusion criteria

• Subject is ≥ 18 years of age
• Subject requires implantation or replacement of a dual chamber pacemaker or requires an upgrade from a single chamber to a dual chamber pacemaker.
• Subject has stable (for prior 1 month) hypertension treatment with 1, 2 or 3 antihypertensive drugs, which is planned to be maintained without changes for a period of at least 2 months post implant.
• Subject has an office systolic blood pressure (oSBP) ≥140 and \<180 mmHg
• At 4 weeks from device implant, subject has an average 24-Hour ambulatory systolic blood pressure (aSBP) ≥130 mmHg and \<170 mmHg and an office blood pressure (oSBP) ≥140 and \<180 mmHg.
• Subject is willing and able to comply with study visits and procedures
• Subject is willing to adhere to the prescribed baseline antihypertension medical regimen for the duration of the study.

Exclusion criteria

• 1\. Subject has a known secondary cause of HTN (e.g. renal vascular disease, hyperthyroidism, hyperaldosterone and pheochromocytoma)
• Subject has permanent atrial fibrillation
• Subject has intermittent paroxysmal atrial fibrillation/flutter with significant burden (i.e., \>10% atrial fibrillation/flutter beats if available.
• Subject has an ejection fraction \<50%
• Subject has a drop of \> 15% (absolute) in ejection fraction from baseline to week 4
• Subject has symptoms of heart failure, NYHA Class II or greater
• Subject has mitral regurgitation ≥2+, aortic stenosis with valve area \<1.0 cm2 , or is expected to need a valve repair or replacement.
• Subject has a history of stroke or TIA within 12 months or any prior stroke with a residual neurological deficit (modified Rankin Score \>2+)
• Subject experienced myocardial infarction (MI) within 3 months prior to enrolment
• Subject had a cardiovascular interventional procedure or cardiovascular surgery within 6 months prior to enrolment
• Subject has hypertrophic cardiomyopathy, restrictive cardiomyopathy or interventricular septal thickness ≥15 mm
• Subject is on dialysis
• Subject has estimated glomerular filtration rate (GFR) \<30 ml/min/1.73m²
• Subject has significant (\>50% occlusion of left or right carotid artery) carotid artery stenosis
• Subject has a history of clinically significant untreated ventricular tachyarrhythmia or has experienced sudden cardiac arrest
• Subject has an active device-based treatment for hypertension
• Subject has an existing active cardiac device or neurostimulator (e.g., ICD, spinal cord stimulator)
• Subject has Type I Diabetes
• Subject is a member of a vulnerable population (e.g., prisoners, pregnant or lactating women, mentally disabled)
• Subject has the possibility of becoming pregnant during the conduct of the study and is not willing to use a means of contraception during the study
• Subject cannot or is unwilling to provide informed consent