Non-invasive hemodynamic monitoring as a guide to drug treatment of uncontrolled hypertensive patients: effects on home blood pressure in the BEAUTY study

Talvik, Anneli; Rebora, Paola; Heinpalu-Kuum, Marika; Salerno, Sabrina; Miszkowska-Nagórna, Eliza; Liu, Xiaoqiu; Comotti, T.; Świerblewska, Ewa; Valsecchi, Maria Grazia; Elmula, Fadl Elmula M. Fadl; Larstorp, Anne Cecilie K.; Parati, Gianfranco; Laurent, Stéphane; Viigimaa, Margus

doi:10.1080/08037051.2018.1505425

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…Our neutral results are consistent with the findings of the BEAUTY Study, which showed that noninvasive hemodynamic assessment combined with a drug selection algorithm did not result in a better reduction of daytime SBP in ambulatory BP monitoring among uncontrolled hypertensive patients [16]. The subanalysis of home BP measurements in the BEAUTY study; however, showed that the drug selection based on hemodynamic monitoring significantly improved home BP after 6 months compared with the control group (P ¼ 0.002) [17]. Similarly, a randomized prospective controlled trial in 2016 using impedance cardiography (ICG)-guided antihypertensive therapy showed a greater BP reduction in the ICG-guided group among the patients with higher BP but did not significantly reduce BP among patients with slightly elevated BP [21].…”

Section: Discussionsupporting

confidence: 89%

“…Additionally, the systems report not only an estimation of the cardiac output and other hemodynamic modulators but also generates a hemodynamic profile expressed as hemodynamic map showing deviations of volemia, inotropy, chronotropy, and vasoactivity from their normal range (Supplementary digital Figure 1, http://links.lww.com/HJH/B545) [10]. The HOTMAN System has been validated against invasive measurement (thermodilution method) of the cardiac index (CI) [13] and has been used in previous studies, for example, to assess hemodynamic patterns in patients with various forms of hypertension, in obese patients [14], or to guide treatment decisions in patients with resistant or uncontrolled hypertension [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic profiles in treatment-naive arterial hypertension and their clinical implication for treatment choice: an exploratory post hoc analysis

Glinz¹,

Blasi²,

Villiger

et al. 2020

Journal of Hypertension

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See editorial comment on page 1109Objective: Noninvasive thoracic bioimpedance by the HOTMAN System estimates hemodynamic modulators and expresses them as hemodynamic profiles. Aims of this analysis were to describe hemodynamic profiles among treatment-naive hypertensive patients compared with normotensive controls and to investigate whether a hemodynamic-guided choice of therapy improves blood pressure (BP) control within 4 weeks.Method: This exploratory post hoc analysis used data of a randomized parallel-group trial including 80 outpatients with newly diagnosed arterial hypertension (AHT), randomized to four antihypertensive first-line monotherapies, and 20 age-matched and sex-matched normotensive controls. Hemodynamic profiles were measured at baseline and after four weeks of treatment. On the basis of the hemodynamic profiles, the most appropriate pharmacological treatment was determined retrospectively and patients were categorised to have received concordant (ConTG) or discordant treatment (DisTG).Results: In the hypertensive group, hypervolemia with vasoconstriction was the predominant hemodynamic profile in 48% of patients and hypervolemia without vasoconstriction in 45%, compared with 15 and 50%, respectively, in the control group. After 4 weeks of treatment, the mean (AESD) 24-h BP was 129.9 (AE11.0)/ 81.5 (AE8.0) mmHg in the DisTG vs. 133.9 (AE12.3)/84.0 (AE9.1) mmHg in the ConTG (P ¼ 0.158/0.222). The mean 24-h BP reductions were À9.7 (AE10.1)/À5.0 (AE6.2) mmHg in the DisTG and À12.4 (AE14.8)/À6.9(AE6.9) mmHg in the ConTG (P ¼ 0.353/0.223). After 4 weeks of treatment, the BP control rate was 53.7% (43/80) among all, 55.7% (29/52) in the DisTG and 48% (12/25) in the ConTG (P ¼ 0.628). Conclusion:Our findings do not support the hypothesis that personalized treatment initiation based on hemodynamic profiles improves BP control in newly diagnosed hypertensive outpatients.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Hemodynamic profiles in treatment-naive arterial hypertension and their clinical implication for treatment choice: an exploratory post hoc analysis

Glinz¹,

Blasi²,

Villiger

et al. 2020

Journal of Hypertension

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“…Some trials have demonstrated the usefulness of hemodynamic profiling combined with a treatment algorithm for hypertensive patients with other impedance cardiography devices [14]. However, our previous study on hemodynamic profiling with the HOTMAN system to guide the antihypertensive therapy in each individual patient provided similar office and ambulatory BP changes as achieved by clinical hypertension experts [13], although home BP was reduced more in the group with therapeutic decisions based on the HOTMAN measurements [27]. Based on the small additional value of HOTMAN measurements to guide therapy in difficult-to-control hypertension, we cannot recommend its application in general clinical practice yet, but we do believe the HOTMAN measurements are of pathophysiological interest in research, as used in the present study.…”

Section: Interpretation Of the Resultsthe Control Groupmentioning

confidence: 95%

Renal sympathetic denervation lowers systemic vascular resistance in true treatment-resistant hypertension

et al. 2020

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Renal sympathetic denervation (RDN) is again gaining interest as recent well-designed trials have demonstrated reduced ambulatory blood pressure (BP) after RDN. However, the hemodynamic mechanisms have not been elucidated. We aimed for the first time to investigate the effect of RDN on the "Hallmark of Hypertension" namely increased systemic vascular resistance index (SVRI). Materials and methods:We investigated SVRI change in patients with true treatment-resistant hypertension randomized to RDN (n=9) or drug adjusted control (n=9). Treatment-resistant hypertension was defined as office systolic BP ≥ 140 mmHg despite ≥ 3 antihypertensive drugs including a diuretic. True treatment-resistant hypertension was confirmed prior to inclusion with ambulatory daytime systolic BP ≥ 135 mmHg immediately after witnessed intake of antihypertensive drugs. Hemodynamic variables were recorded with thoracic impedance cardiography at baseline and at three and six months follow-up after RDN. This non-invasive method also guided further tailoring of drug treatment in the control group aiming to normalize hemodynamic variables and BP. Results: From three to six months follow-up after RDN, SVRI decreased with a median of -611 dyn*s*m 2 /cm 5 [IQR -949 to -267] (p<0.01), while supine mean BP decreased with a median of -11 mmHg [IQR -21 to -3] (p=0.02). In the same period, SVRI in the control group was reduced with -674 dyn*s*m 2 /cm 5 [IQR -1,309 to -340] (p<0.01), while supine mean BP decreased with -15 mmHg [IQR -29 to -6] (p=0.01). Thus, hemodynamic variables and BP in the two groups normalized in parallel. Conclusion:Our data suggest that in patients with true treatment-resistant hypertension, renal sympathetic denervation lowers BP by reducing systemic vascular resistance of similar size as in the control group with careful individual selection of antihypertensive drugs and dose titration.

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“…Better monitoring is one way, use of decision support is another possibility, e.g. utilising non-invasive monitoring of hemodynamic parameters combined with a drug selection algorithm [32].…”

Section: Discussionmentioning

confidence: 99%

PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care

et al. 2019

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Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.

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Non-invasive hemodynamic monitoring as a guide to drug treatment of uncontrolled hypertensive patients: effects on home blood pressure in the BEAUTY study

Cited by 4 publications

References 15 publications

Hemodynamic profiles in treatment-naive arterial hypertension and their clinical implication for treatment choice: an exploratory post hoc analysis

Hemodynamic profiles in treatment-naive arterial hypertension and their clinical implication for treatment choice: an exploratory post hoc analysis

Renal sympathetic denervation lowers systemic vascular resistance in true treatment-resistant hypertension

PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care

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