Safety and Performance Study of the Moderato System

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