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Who benefits more from hemodynamically guided hypotensive therapy? The experience from two randomized, prospective

Paweł Krzesiński1, Grzegorz Gielerak2, Adam Stańczyk2

  • 1Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, 04-141 Warsaw 44, Poland pkrzesinski@wim.mil.pl.

Therapeutic Advances in Cardiovascular Disease
|December 5, 2015
PubMed

Insights

Impedance cardiography (ICG)-guided antihypertensive therapy significantly reduces blood pressure (BP) more effectively than empiric treatment, particularly in patients with more elevated baseline BP. For those with slightly increased BP, both approaches show comparable results.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Hypertension Management

Background:

  • Arterial hypertension (AH) management can be complex due to factors like fluid retention and vascular resistance.
  • Impedance cardiography (ICG) aids in personalizing antihypertensive therapy, but its specific benefits for patient subgroups are not fully understood.

Purpose of the Study:

  • To evaluate the effectiveness of ICG-guided antihypertensive therapy compared to empiric treatment over 12 weeks.
  • To determine if baseline blood pressure (BP) influences the benefit of ICG-guided therapy.

Main Methods:

  • A randomized controlled trial involving 272 patients with AH.
  • Patients received either empiric (GE) or ICG-guided (HD) antihypertensive therapy.
  • Subgroup analysis based on median mean blood pressure (MBP) of 110 mmHg: slightly increased BP (SI_BP) and more increased BP (MI_BP).

Main Results:

  • ICG-guided therapy (HD) demonstrated superior BP reduction in the MI_BP subgroup compared to empiric therapy (GE).
  • Significant differences favoring HD were observed in office and 24-h SBP and DBP changes, as well as the percentage of patients achieving ≥10 mmHg BP reduction.
  • No significant differences were found between GE and HD in the SI_BP subgroup.

Conclusions:

  • Hemodynamically guided pharmacotherapy, particularly using ICG, leads to greater BP reduction.
  • The benefit of ICG-guided therapy is more pronounced in patients with higher baseline BP.
  • For patients with slightly elevated BP, empiric therapy may be as effective as ICG-guided treatment.
Abstract

Keywords:
antihypertensive agentsblood pressurecardiovascular diseaseshemodynamicshypertensionimpedance cardiography

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