Understanding the Haemodynamics of Hypertension

Abstract

Outdated understanding of haemodynamics based on previous measurement systems can no longer be applied to our understanding of the circulation. We question the current view of hypertension as defined by a predominantly systolic blood pressure and introduce the concept of vasogenic, cardiogenic and mixed-origin hypertension. We postulate that failure to identify the individual's haemodynamic pattern may lead to the use of inappropriate medication, which in turn may be a major factor in patient non-compliance with therapeutic strategies. A population-based approach to treatment of hypertension may lead to suboptimal functional dynamics in the individual patient. Finally, we question the validity of current guidelines and published evidence relating morbidity and mortality to the future treatment of hypertension. The importance of individual haemodynamic profiles may be pivotal in the understanding, diagnosis and treatment of hypertension if optimal control with minimal adverse effects is to be achieved. Research based on individual haemodynamic patterns is overdue.

Maternal Hypertension, Advanced Doppler Haemodynamics and Therapeutic Precision: Principles and Illustrative Cases

“…SMII is a novel measure of ventricular inotropy based on quantitation of the potential and kinetic energy of the circulation indexed to the time of ventricular ejection [ 26 ] and is an improved index of total cardiovascular load in W/m 2 . The USCOM 1A has been proven to be reliable, reproducible and more sensitive than bio-impedance [ 18 , 27 ••, 28 •, 29 ], and more feasible to use than echocardiography [ 27 ••], with measurements acquired in a few minutes [ 14 ••]. Established normal haemodynamic reference values across pregnancy [ 14 ••, 19 ••] and a high sensitivity to SV change ensure early detection of circulatory dysregulation and accurate identification of appropriate therapy and monitoring of therapeutic response.…”

Haemodynamics of Hypertension in Children

“…As the product of cardiac output (CO) and systemic vascular resistance (SVR, through the definition of SVR as a resistance by analogy to Ohm’s law), an elevated MAP may be due to elevation in CO, SVR or both. This has led to the concept that hypertension could be cardiac related (high CO), vascular related (high SVR) or mixed due to a combination of increased CO and SVR [ 21 ].…”

Mi visión ante el paciente hipertenso

“…Existen, por tanto, diversos perfiles hemodinámicos en los pacientes hipertensos esenciales. Las características hemodinámicas del paciente joven difieren de las observadas en el paciente de edad media o en el adulto mayor 8 , y también son diferentes las respuestas neuroendocrina y renal. Por ende, considerar que todos los pacientes hipertensos están bajo la misma carga de sustancias vasoconstrictoras o con los mismos cambios en el volumen vascular es un error conceptual que tiene consecuencias para el diagnóstico y el tratamiento.…”