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Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance
Shiwani Mahajan1, Jianlei Gu2, Yuan Lu3
1Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
Insights
Hypertension subtypes vary hemodynamically. Identifying these blood pressure phenotypes in a large outpatient group reveals distinct cardiac output and systemic vascular resistance patterns, aiding personalized treatment.
Area of Science:
- Cardiology
- Hypertension Research
- Physiology
Background:
- Blood pressure is a key indicator of cardiac output and systemic vascular resistance.
- Understanding hemodynamic phenotypes could help classify hypertension subtypes and guide treatment.
- Previous studies lacked data on hemodynamic phenotypes in large, stable outpatient hypertensive populations.
Purpose of the Study:
- To characterize hemodynamic phenotypes in a large cohort of hypertensive outpatients.
- To investigate the association between patient characteristics and hemodynamic parameters.
Main Methods:
- Analyzed data from 33,414 hypertensive patients (systolic blood pressure ≥130 mm Hg) in China.
- Measured hemodynamic parameters including cardiac index and systemic vascular resistance index using impedance cardiography.
- Assessed associations between patient characteristics and the ratio of cardiac index to systemic vascular resistance index.
Main Results:
- Identified distinct hemodynamic phenotypes across different systolic blood pressure categories.
- Found that 70% of patients with systolic blood pressure 140-159 mm Hg had high systemic vascular resistance index with normal/low cardiac index.
- Cardiac index to systemic vascular resistance index ratio was negatively associated with age and body mass index, but these factors explained little variation.
Conclusions:
- Hemodynamic blood pressure phenotypes are diverse within hypertensive categories.
- While individual characteristics correlate with hemodynamic ratios, they offer limited explanatory power for variations.
- Further research is needed to fully understand and utilize these phenotypes for hypertension management.
Background:
Blood pressure is a physiologic measure that reflects cardiac output and systemic vascular resistance. Classification by these components could be useful in characterizing subtypes of hypertension, which may have a role in selecting treatment strategies. However, hemodynamic phenotypes of a large, stable, outpatient population with hypertension remain unknown.
Methods:
We included 34,238 people with systolic blood pressure of ≥130 mm Hg, who underwent impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between 2012 and 2018. Hemodynamic parameters measured included stroke volume, stroke volume index, heart rate, cardiac output, cardiac index, systemic vascular resistance, and systemic vascular resistance index. We characterized these by systolic blood pressure categories and assessed patient characteristics associated with the ratio of cardiac index to systemic vascular resistance index.
Results:
Among the study cohort (n = 33,414; mean age 52 ± 13 years; 36.6% female), 49%, 40%, and 11% had systolic blood pressure130-139, 140-159, and ≥160 mm Hg, respectively. Among patients with systolic blood pressure 140-159 mm Hg, 9353 (70%) had high systemic vascular resistance index but normal/low cardiac index, 1949 (15%) had high cardiac index but low/normal systemic vascular resistance index, and 2053 (15%) had low/normal cardiac index and systemic vascular resistance index. Using multivariable analysis, we found that cardiac index to systemic vascular resistance index ratio was negatively associated with age and body mass index (all P <0.05; R-square 0.16, 0.12, and 0.09 for systolic blood pressure 130-139, 140-159 and ≥160 mm Hg, respectively).
Conclusions:
Different hemodynamic blood pressure phenotypes were identified across all hypertensive blood pressure categories. Although individual characteristics were associated with the cardiac index to systemic vascular resistance index ratio, they only weakly explained the variation.
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