Neuroprosthetic closed-loop strategy for sustained blood pressure reduction via simultaneous stimulation and recording from the spinal cord.

Sympathetic hyperactivity is a common feature observed in both primary and secondary hypertension, and neuromodulation-based therapies targeting this overactivity are under active investigation. The intermediolateral nucleus (IML) in the spinal cord plays a central role in sympathetic regulation, and its direct stimulation induces a transient, frequency-dependent reduction in blood pressure. However, this effect gradually diminishes as the baroreflex restores blood pressure to baseline. Therefore, this study aims to develop a closed-loop (CL) stimulation system that adjusts parameters in real-time based on neural activity recorded from the IML and to enhance and prolong the transient antihypertensive effect. This strategy was evaluated in normotensive and angiotensin II-induced hypertensive rat models and compared to open-loop (OL) stimulation of equal intensity. In both models, CL stimulation produced a more sustained blood pressure reduction than that of OL stimulation. These findings suggest that CL spinal cord stimulation offers a more effective and durable therapeutic option for treating hypertension.