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

• Published in: Cardiology journal 2016, Vol.23 (2), p.132-140
• Main Authors: Krzesiński, Paweł, Gielerak, Grzegorz, Stańczyk, Adam, Piotrowicz, Katarzyna, Uziębło-Życzkowska, Beata, Banak, Małgorzata, Kurpaska, Małgorzata, Michalczyk, Łukasz, Jurek, Agnieszka, Wolszczak, Kalina, Galas, Agata, Wójcik, Agnieszka, Skrobowski, Andrzej
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antihypertensive Agents - administration & dosage; Blood pressure; Blood Pressure - drug effects; Blood Pressure Monitoring, Ambulatory; Cardiography, Impedance; Dose-Response Relationship, Drug; Echocardiography; Female; Follow-Up Studies; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Male; Middle Aged; Prospective Studies; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/CJ.a2016.0009

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). 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. 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 of-fice 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. 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.