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Effect of routinely tailoring anti-hypertensive therapy to hemodynamic profile in primary care
John Gf Cleland1, Douglas E Romer2, Raymond A Kaiser2
1School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Lanarkshire, United Kingdom.
Insights
Tailoring hypertension treatment using impedance cardiography (ICG) achieved significant blood pressure (BP) control in primary care. This personalized approach led to rapid, sustained BP management and reduced rates of heart attack and stroke.
Area of Science:
- Cardiology
- Hypertension Management
- Medical Technology
Background:
- Effective blood pressure (BP) control is crucial for reducing cardiovascular disease but remains a challenge in clinical practice.
- Impedance cardiography (ICG) offers a method to personalize hypertension therapy based on individual hemodynamic profiles.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of tailoring anti-hypertensive therapy using ICG-derived hemodynamic profiles in primary care settings.
- To assess the impact of this tailored approach on achieving and sustaining BP control and reducing cardiovascular events.
Main Methods:
- An observational study involving 14,058 hypertensive patients across two primary care groups (PriMED and Premier).
- Utilized therapeutic algorithms based on ICG-derived hemodynamics integrated with clinical decision support tools.
- BP control was defined as <140/<90 mmHg; clinical outcomes were tracked via electronic medical records.
Main Results:
- Achieved high BP control rates: 92% at second follow-up in PriMED, and 81% to 93% in Premier over time.
- Identified distinct hemodynamic profiles: vasoconstriction (47%), hyperdynamic (24%), and mixed (29%).
- In a subset followed for six years, annual rates of myocardial infarction and stroke were low (0.30% and 0.43%, respectively).
Conclusions:
- Tailoring anti-hypertensive medication based on hemodynamic profiles is a feasible primary care strategy.
- This approach enables rapid and sustained blood pressure control.
- The method is associated with significantly low rates of myocardial infarction and stroke.
Purpose:
Controlling blood pressure (BP) reduces cardiovascular morbidity and mortality but is often not achieved in clinical practice. Tailoring therapy to an individual's hemodynamic profile using impedance cardiography (ICG) might attain efficient, effective BP control.
Methods:
An observational study of hypertensive patients managed by two large US primary care groups (PriMED and Premier) used therapeutic algorithms based on ICG-derived hemodynamics linked to clinical decision support tools to promote physician and patient engagement and medication adherence. The main outcome of interest was BP control according to contemporary (2014) guidelines (<140/<90 mmHg). A subset of PriMED patients was followed for six years, to evaluate clinical outcomes. Clinical information was extracted from electronic medical records.
Results:
Of 14,058 patients, median (interquartile range (IQR)) age was 62 (51 to 71) years, 50% were women, and initial systolic and diastolic BP were 152 (145-162) mmHg and 90 (80-98) mmHg. The hemodynamic profile was vasoconstriction for 6,609 (47%) patients, hyperdynamic for 3,365 (24%) and mixed for 4,084 (29%). For PriMED, 92% achieved BP control at the second follow-up visit. For Premier, 81% achieved control at second follow-up, and 91% by the fourth visit. Annual control rates thereafter for both groups ranged from 82% to 93%. For 2,955 patients continuously managed by PriMED between 2016-2022, annual rates of myocardial infarction and stroke were 0.30% and 0.43%.
Conclusions:
Tailoring anti-hypertensive therapy according to hemodynamic profile in primary care is feasible, providing rapid and sustained BP control with low rates of myocardial infarction and stroke.
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