Noninvasive ear nerve stimulation shows promise for uncontrolled high blood pressure in SCRATCH-HTN trial

The SCRATCH-HTN clinical trial, led by Queen Mary University of London, evaluated transcutaneous autonomic neuromodulation (tAN), a noninvasive ear-stimulation device developed by Afferent Medical Solutions for uncontrolled hypertension. While the trial of 63 patients showed no overall significant blood pressure reduction compared to sham, a subgroup with severe hypertension experienced clear reductions. This comes as a study of 1.4 million English adults found 37% have hypertension, with 59% of those undiagnosed.

The SCRATCH-HTN clinical trial

• ▪The SCRATCH-HTN clinical trial, led by Queen Mary University of London, evaluated a noninvasive ear nerve stimulation technique for 63 patients with uncontrolled high blood pressure.
• ▪A prespecified subgroup analysis of the SCRATCH-HTN trial showed a greater blood pressure reduction in active treatment participants who had more severe hypertension at baseline.
• ▪The SCRATCH-HTN trial did not find a statistically significant difference in blood pressure reduction between the active treatment and sham groups across the overall study population.
• ▪Participants in the SCRATCH-HTN trial used the ear nerve stimulation device for 30 minutes daily for two weeks, followed by once-weekly sessions for 10 weeks.

Transcutaneous autonomic neuromodulation technology

• ▪Transcutaneous autonomic neuromodulation is a noninvasive technique designed to influence the autonomic nervous system to regulate blood pressure.
• ▪The transcutaneous autonomic neuromodulation treatment was found to be safe, well tolerated, and easy for patients to administer themselves at home.
• ▪The transcutaneous autonomic neuromodulation device, developed by Afferent Medical Solutions, delivers gentle electrical stimulation through two clips attached to the ear's tragus.

Hypertension prevalence in the Our Future Health study

• ▪After adjusting for age, hypertension in the Our Future Health study affected 42% of men compared to 29% of women.
• ▪A study of 1.4 million adults in England enrolled in the Our Future Health programme between 2022 and 2025 found that 37% had hypertension.
• ▪Hypertension prevalence in the Our Future Health study rose from 15% among 18-to-39-year-olds to 71% among individuals aged 80 and over.

Hypertension diagnosis and treatment rates

• ▪Among the Our Future Health study participants identified with hypertension, 59% had not been previously diagnosed and were not taking blood-pressure-lowering medication.
• ▪Half of the Our Future Health study participants who were already taking blood-pressure-lowering medication still had high blood pressure.

Community pharmacy blood pressure checks

• ▪The NHS England Community Pharmacy Hypertension Case-Finding Service allows referrals from GPs and other healthcare professionals, including dentists and optometrists.
• ▪Since 2021, NHS England has operated the Community Pharmacy Hypertension Case-Finding Service, offering free blood pressure checks to undiagnosed individuals aged 40 and over.

NHS England survey on blood pressure awareness

• ▪In the NHS England survey, 17% of people who had not recently measured their blood pressure avoided doing so because they felt healthy or unstressed.
• ▪An NHS England survey of adults aged over 40 found 44% were unaware of free pharmacy blood pressure checks, and 59% did not know they were available without an appointment.

Debatable claims

• ▪The healthcare system, rather than the individual, bears primary responsibility for blood pressure screening
• ▪Expanding routine blood pressure screening to younger adults is an effective use of healthcare resources