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Use of diuretic agents in obese or black patients with systemic hypertension
Insights
Hypertension presents differently across age groups and demographics. Understanding these unique hemodynamic profiles is key to effective treatment strategies for essential hypertension.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Arterial pressure elevation results from increased cardiac output, total peripheral resistance, or both.
- Hypertension is a heterogeneous condition with varying pathophysiological mechanisms throughout a patient's lifespan.
- Different patient subgroups exhibit distinct hemodynamic characteristics.
Purpose of the Study:
- To delineate the varied hemodynamic profiles of essential hypertension in different patient populations.
- To inform a rational therapeutic approach by considering these pathophysiological differences.
- To guide initial antihypertensive therapy selection based on patient characteristics.
Main Methods:
- Hemodynamic characterization of hypertensive patients across different age groups (young, middle-aged, elderly).
- Subgroup analysis including obese and Black hypertensive patients.
- Comparison of cardiac output, intravascular volume, and total peripheral resistance.
Main Results:
- Young, nonobese patients: high cardiac output, normal/low volume, normal resistance.
- Middle-aged/elderly patients: normal/low cardiac output, contracted volume, high resistance.
- Obese patients: high cardiac output, expanded volume, normal/low resistance. Black patients show similar findings but with lower heart rates and greater volume depletion responsiveness.
Conclusions:
- Essential hypertension requires a tailored therapeutic strategy based on distinct patient profiles.
- Thiazide diuretics are suitable initial therapy for obese and Black hypertensive patients.
- Obese and Black hypertensive patients are at higher risk for early left ventricular hypertrophy.
Abstract:
Any increase in arterial pressure is the result of either an increase in cardiac output, an increase in total peripheral resistance or a combination of the two. Hypertension is not a homogeneous disease, however, and different mechanisms may be operative during the life span of the patient. Hypertension in the young, nonobese patient is usually hemodynamically characterized by high cardiac output, normal to slightly contracted intravascular volume and numerically normal total peripheral resistance. In contrast, hypertension in the middle-aged or elderly patient is usually hemodynamically characterized by normal to low cardiac output, contracted intravascular volume and high total peripheral resistance. Two further subgroups of hypertensive patients can be identified: obese patients, whose hypertension is characterized by high cardiac output, expanded intravascular volume and normal or low total peripheral resistance, and black patients, whose hemodynamic and fluid volume findings are similar to those of their white counterparts, but who tend to have lower heart rates and greater responsiveness to intravascular volume depletion than white hypertensive subjects. A rational therapeutic approach to essential hypertension should take into account these variable pathophysiologic features. Thiazide diuretics continue to be appropriate and generally well-tolerated choices for initial antihypertensive therapy in obese or in black patients. Many obese patients or black patients, however, are likely to develop early left ventricular (LV) hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)