Individualizing Antihypertensive Combination Therapies: Clinical and Hemodynamic Considerations

Taler, Sandra J.

doi:10.1007/s11906-014-0451-y

Cited by 12 publications

(5 citation statements)

References 25 publications

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“…We must emphasize that the justification of this retrospective analysis grew from the clinical need to improve diagnostic power of noninvasive hemodynamic assessment by ICG. The defined cut-offs of supBP raise the practical convenience of the method that is perceived as prospective in diagnosis and treatment of AH [ 30 ]. We are aware that several BP measurements during a 10-minute rest in the supine position are undoubtedly more difficult to perform and the supBP will not replace standard sitting BP measurement.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of supine blood pressure in hypertension

Krzesiński¹,

Stańczyk²,

Gielerak³

et al. 2016

aoms

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IntroductionCorrect blood pressure (BP) measurement is crucial in the diagnosis of arterial hypertension (AH), and controversy exists whether supine BP should be treated as equal to sitting BP. The aim of this study was to evaluate the relation of supine BP to sitting BP and ambulatory BP with regard to identification of diagnostic cut-offs for hypertension.Material and methodsThis study included 280 patients with AH (mean age: 44.3 ±10.6 years). The following measurements of BP were performed and analyzed: 1) sitting office blood pressure measurement (OSBP and ODBP); 2) supine BP (supSBP and supDBP), measured automatically (5 times with a 2-minute interval) during evaluation by the Niccomo device (Medis, Germany); 3) 24-hour ambulatory blood pressure (ABP) monitoring.ResultsThe mean supSBP and supDBP were found to be lower than OSBP and ODBP (130.9 ±14.2 vs. 136.6 ±15.5 mm Hg and 84.8 ±9.4 vs. 87.8 ±10.2 mm Hg, respectively; p < 0.000001). The correlations between ABP and supBP/OBP were moderate and strong (correlation coefficients in range 0.55–0.76). The ROC analysis revealed that mean supBP ≥ 130/80 mm Hg was more precise than OBP ≥ 140/90 mm Hg in diagnosing hypertension (AUC: 0.820 vs. 0.550; sensitivity 80.7% vs. 57.4%; specificity 83.2% vs. 52.7%; p < 0.0001) and the additive value derived mostly from its higher predictive power of identifying patients with increased night-time BP.ConclusionsIn young and middle-aged hypertensive patients the blood pressure during a 10-minute supine rest was lower than in the sitting position. The supine blood pressure ≥ 130/80 mm Hg was found to be a specific and sensitive threshold for hypertension.

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Section: Discussionmentioning

confidence: 99%

The diagnostic value of supine blood pressure in hypertension

Krzesiński¹,

Stańczyk²,

Gielerak³

et al. 2016

aoms

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show abstract

“…This easy to perform, repeatable and low-cost noninvasive method of hemodynamic monitoring provides the evaluation of LV performance, arterial compliance, vascular tone and thoracic fluid content (TFC). [10][11][12] This synchronous assessment might reflect the complexity of hemodynamic changes related to aging and hypertension. Thus, to verify this hypothesis we performed the retrospective analysis of ICG records in a group of unmedicated hypertensive adults, assuming potential differences between men and women.…”

Section: Introductionmentioning

confidence: 99%

The hemodynamic patterns in hypertensive men and women of different age

et al. 2015

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Aging is associated with cardiovascular remodeling, which can be accelerated in arterial hypertension (AH). The aim of this study was to evaluate the relation between hemodynamic profile and age, as well as to identify the role of sex in hemodynamic patterns of aging in AH. The study comprised 326 patients with AH (mean age: 44.3 years). Two-dimensional echocardiography was performed to evaluate, that is, left ventricular diastolic dysfunction (LVDD) and ejection fraction (LVEF), and ICG to evaluate, that is, acceleration time index (ACI), velocity index (VI), total arterial compliance (TAC), systemic vascular resistance index (SVRI) and thoracic fluid content (TFC). The statistical analysis included interquartile comparison in subgroups of age <19-37 years (Q1), 38-44 years (Q2), 45-51 years (Q3) and 52-68 years (Q4). Aging was associated with: (1) higher prevalence of LVDD (Q1 vs Q4: 11.0% vs 24.7%, P=0.023); (2) altered LV systolic performance-ACI (81.4 vs 64.0 1/100 Ω s(-2), P=0.0001), VI (50.5 vs 42.8 1/1000 Ω s(-1), P=0.006), LVEF (65.4% vs 67.0%, NS); and (3) increased afterload-TAC (2.25 vs 1.87 ml mm Hg(-1), P=0.0001), SVRI (2182 vs 2407 dyn s m(2) cm(-)(5); P=0.045). The 'U-shaped' relation to age was observed for TFC. The above-mentioned hemodynamic trends were more pronounced in men, whereas females presented the 'middle-aged delay'. The influence of aging on cardiovascular system shows in progressive arterial stiffness and impaired left ventricular function. Thoracic fluid reduction may be compensatory to vasoconstriction but its efficiency declines with age. The patterns of cardiovascular aging are different in men and women.

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“…In such a non-homogeneous group [1,48] the use of varied regimens, based on individual hemodynamic profiles may be a better management strategy. Therefore, ICG may be a practical tool in this group of patients, as its usefulness in selecting optimal treatments based on the individual hemodynamic disturbances has been already demonstrated in patients with hypertension [49,50].…”

Section: Discussionmentioning

confidence: 99%

Clinical presentations and hemodynamic parameters in patients hospitalized due to acute heart failure stratified by the left-ventricular ejection fraction

Galas

Krzesiński

Gielerak

et al. 2018

Medical Research Journal

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Background: Currently, one of the most common causes of hospitalization, especially in the elderly, is heart failure (HF) exacerbation. In nearly 95% of patients, this is caused by fluid overload. There have been studies comparing the rates of comorbidities and biochemical disturbances in HF patients; however, their hemodynamic parameters have not yet been assessed. Thus, the aim of this study was to compare the clinical presentations and hemodynamic parameters assessed via impedance cardiography (ICG) in patients hospitalized due to acute HF, stratified by the left-ventricular ejection fraction (LVEF). Methods: This study enrolled 102 patients, aged > 18 years, hospitalized due to decompensated HF. Ninety-seven patients (74 men, 23 women) underwent echocardiographic examination. Biochemical and hemodynamic parameters were assessed on the day of admission and, subsequently, every other day during hospitalization. Based on echocardiographic findings and the ESC guidelines the study group was divided into the following subgroups: HFrEF (EF < 40%), HFpEF (EF > 50%), and HFmrEF (EF 40-49%). Results: The HFrEF group, which constituted 60.8% of patients (n = 58), was predominantly male (P = 0.0005); and most had elevated N-terminal pro-brain natriuretic peptide levels (P = 0.0008). The HFpEF and HFmrEF subgroups, jointly (n = 38), were characterized by higher systolic blood pressure (P = 0.0001), and lower hemoglobin levels (P = 0.003). The hemodynamic assessment showed that HFrEF patients had higher total fluid content (P = 0.005) and lower systolic time ratio (P = 0.0002). Conclusions: Despite similar clinical presentation, patients with HF exhibited different values of hemodynamic and biochemical parameters depending on their LVEF; this indicates non-homogeneity of pathomechanisms and causes of HF decompensation.

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Individualizing Antihypertensive Combination Therapies: Clinical and Hemodynamic Considerations

Cited by 12 publications

References 25 publications

The diagnostic value of supine blood pressure in hypertension

The diagnostic value of supine blood pressure in hypertension

The hemodynamic patterns in hypertensive men and women of different age

Clinical presentations and hemodynamic parameters in patients hospitalized due to acute heart failure stratified by the left-ventricular ejection fraction

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