The purpose of the study is to evaluate the safety and performance of the Moderato System by implanting the Moderato pacemaker in patients who require a dual chamber pacemaker, and who also have hypertension, in order to reduce their blood pressure.

Inclusion Criteria:

• Subject is ≥ 18 years of age
• Subject is indicated for implantation or replacement of a dual chamber permanent pacemaker where no lead extraction is necessary.
• Subject has stable regimen of 2 or more maximally tolerated anti-hypertension medications, which is anticipated to be able to be maintained without changes for 3 months.
• Subject has office systolic blood pressure measurements > 140 mmHg on two separate days within a one week period prior to enrollment, and the average of these two measurements is ≥150 mmHg

Exclusion Criteria:

• Subject has known secondary cause of HTN
• Subject has a history of atrial fibrillation
• Subject has ejection fraction <50%
• Subject has symptoms of heart failure of NYHA Class II or more
• 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 prior neurological events (stroke or TIA) or carotid artery disease
• Subject has known autonomic dysfunction
• Subject has a history of clinically significant tachyarrhythmia
• Subject has had previous active device-based treatment for hypertension
• Subject has an existing implant, other than a pacemaker that needs replacing
• Subject with average Systolic BP >190 mmHg