open access

Vol 23, No 2 (2016)
PREVENTION - Original articles
Published online: 2016-04-29
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The effect of hemodynamically-guided hypotensive therapy in one-year observation: Randomized, prospective and controlled trial (FINEPATH study)

Paweł Krzesiński, Grzegorz Gielerak, Adam Stańczyk, Katarzyna Piotrowicz, Beata Uziębło-Życzkowska, Małgorzata Banak, Małgorzata Kurpaska, Łukasz Michalczyk, Agnieszka Jurek, Kalina Wolszczak, Agata Galas, Agnieszka Wójcik, Andrzej Skrobowski
DOI: 10.5603/CJ.a2016.0009
·
Pubmed: 26876066
·
Cardiol J 2016;23(2):132-140.

open access

Vol 23, No 2 (2016)
PREVENTION - Original articles
Published online: 2016-04-29

Abstract

Background: The use of impedance cardiography (ICG) revealed to provide beneficial blood pressure (BP) lowering effect. However, the follow-up in previous trials was short and brachial BP was the only evaluated hemodynamic variable. Thus, we aimed to estimate the influence of ICG-guided therapy on brachial and central BP, impedance-derived hemodynamic profile and echocardiographic features after 12 months in a randomized, prospective and controlled trial (NCT01996085).

Methods: One hundred and forty-four hypertensives were randomly assigned to groups of empiric (GE) and ICG-guided therapy (HD). Office BP, ambulatory BP monitoring, central BP and echocardiography (left ventricular hypertrophy and diastolic function assessment) were performed before and after 12 months of treatment.

Results: Blood pressure reduction was higher in HD (office BP: 21.8/14.1 vs. 19.9/11.8 mm Hg; mean 24-h BP: 19.0/10.9 vs. 14.4/9.2 mm Hg). However, the only statistically significant differences were: percentage of patients achieving BP reduction of minimum 20 mm Hg for of­fice diastolic BP (27.3% vs. 12.1%; p = 0.034) and mean 24-h systolic BP (49.1% vs. 27.3%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) was the only other beneficial hemodynamic effect.

Conclusions: Beneficial BP lowering effect of hemodynamically-guided pharmacotherapy, observed previously in short-term observation, persists over time. Hemodynamic effects of such a treatment approach, especially those of prognostic value (central BP, myocardial hypertrophy), should be evaluated in further studies including patients with resistant hypertension, heart failure, diabetes mellitus and chronic kidney disease.

Abstract

Background: The use of impedance cardiography (ICG) revealed to provide beneficial blood pressure (BP) lowering effect. However, the follow-up in previous trials was short and brachial BP was the only evaluated hemodynamic variable. Thus, we aimed to estimate the influence of ICG-guided therapy on brachial and central BP, impedance-derived hemodynamic profile and echocardiographic features after 12 months in a randomized, prospective and controlled trial (NCT01996085).

Methods: One hundred and forty-four hypertensives were randomly assigned to groups of empiric (GE) and ICG-guided therapy (HD). Office BP, ambulatory BP monitoring, central BP and echocardiography (left ventricular hypertrophy and diastolic function assessment) were performed before and after 12 months of treatment.

Results: Blood pressure reduction was higher in HD (office BP: 21.8/14.1 vs. 19.9/11.8 mm Hg; mean 24-h BP: 19.0/10.9 vs. 14.4/9.2 mm Hg). However, the only statistically significant differences were: percentage of patients achieving BP reduction of minimum 20 mm Hg for of­fice diastolic BP (27.3% vs. 12.1%; p = 0.034) and mean 24-h systolic BP (49.1% vs. 27.3%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) was the only other beneficial hemodynamic effect.

Conclusions: Beneficial BP lowering effect of hemodynamically-guided pharmacotherapy, observed previously in short-term observation, persists over time. Hemodynamic effects of such a treatment approach, especially those of prognostic value (central BP, myocardial hypertrophy), should be evaluated in further studies including patients with resistant hypertension, heart failure, diabetes mellitus and chronic kidney disease.

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Keywords

hypertension, blood pressure, impedance cardiography, cardiovascular diseases, antihypertensive agents, hemodynamics

About this article
Title

The effect of hemodynamically-guided hypotensive therapy in one-year observation: Randomized, prospective and controlled trial (FINEPATH study)

Journal

Cardiology Journal

Issue

Vol 23, No 2 (2016)

Pages

132-140

Published online

2016-04-29

DOI

10.5603/CJ.a2016.0009

Pubmed

26876066

Bibliographic record

Cardiol J 2016;23(2):132-140.

Keywords

hypertension
blood pressure
impedance cardiography
cardiovascular diseases
antihypertensive agents
hemodynamics

Authors

Paweł Krzesiński
Grzegorz Gielerak
Adam Stańczyk
Katarzyna Piotrowicz
Beata Uziębło-Życzkowska
Małgorzata Banak
Małgorzata Kurpaska
Łukasz Michalczyk
Agnieszka Jurek
Kalina Wolszczak
Agata Galas
Agnieszka Wójcik
Andrzej Skrobowski

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