IDENTIFICATION OF THE HEMODYNAMIC MODULATORS (VOLEMIA, INOTROPY AND VASOACTIVITY) AND HEMODYNAMIC STATUS IN UNCONTROLLED HYPERTENSIVE PATIENTS

Introduction: Despite of the progress of antihypertensive drug treatment, only 20–30% out of the treated patients are achieving blood pressure control. These poor results could be partially due to the fact that doctors are having no possibilities to detect which is the hemodynamic cause of the hypertension (hypervolemia, hyperinotropy or vasoconstriction). Under these circumstances, blood pressure problem is treated like a symptom and selection of antihypertensive agents is often done independently of the hemodynamic profile of the patient.
Objective: Identification of the hemodynamic modulators (volemia, inotropy and vasoactivity) and hemodynamic status (MAP and SI) in uncontrolled hypertensive patients.
Methods: We enrolled in 9 centers 114 uncontrolled hypertensive patients with essential hypertension treated with at least 2 antihypertensive drugs. We implemented HOTMAN® system for noninvasive assessment of hemodynamic modulators and evaluation of the hemodynamic status of the patients.
Results: Office systolic and diastolic BP averaged 156/92 mmHg. Among the whole study group 59 (51.7%) were diagnosed as normodynamic while 33 (29%) as hypodynamic and 22 (19.3%) as hyperdynamic.
Modulators Distribution: One abnormal hemodynamic modulator for 35 (30.7%) patients, two for 22 (19.3) patients and three for 52 (45.6%) patients. Different combinations of hemodynamic modulators were present, the most common being concomitant hypervolemia, hypoinotropy and vasoconstriction – in 46 (40.3%) patients. Antihypertensive drug distribution in this subgroup: 89.1% used diuretics, 30.4% – vasodilator beta-blockers, 21.7% – nonvasodilator beta-blockers, 23.9% – ACEI, 73.9% – ARB, 73.9% – dihydropyridine CCB. Two hemodynamic states correspond to this subgroup: hypodynamic 31 (67.3%) patients and normodynamic 15 (32%) patients.
Conclusion: Data suggest there is a strong relation between hypertension and abnormal hemodynamic modulators. Careful analysis of all hemodynamic modulators should precede pharmacological treatment modification in order to achieve a normohemodynamic status. The clinical benefits potentially offered by a larger use of this technique in the daily management of patients would require to be tested by future longitudinal outcome studies.