Hemodynamic Profile In Controlled And Uncontrolled Hypertensive Patients. Insights From The Sephar Iii Study

Objective: Difficulties in hypertension control may depend, among other factors, on a mismatch between choice of antihypertensive drugs and patient's hemodynamic profile. Aim of this study was to evaluate the hemodynamic (HD) profile of a sample of the adult Romanian hypertensive population through impedance cardiography and to explore its possible implication for hypertension control in the frame of the nation-wide SEPHAR III survey. Design and method: Impedance cardiography with the HOTMAN system was performed in 889 adult hypertensive subjects, randomly selected in the frame of the SEPHAR III survey, at the second study visit, for 5–10 minutes in supine position. 771 of them had valid non-invasive hemodynamic measurements data, with estimates of volemia, vasoreactivity, inotropism and hemodynamic state. Blood pressure was measured with the auscultatory technique in seated position twice, according to ESH guidelines. Results: Analysis of impedance cardiography recordings showed the presence of 22 different HD profiles, 9 of them including hypervolemia.The frequency of any alteration in HD modulators was significantly higher in uncontrolled hypertensives (office BP greater than 140/90 mm Hg) than in controlled ones. Regression analysis revealed a positive association between the number of altered HD modulators and the lack of BP control: 1 altered HD modulator: OR 2.57, 95%CI for OR (1.03–6.45); 2 altered HD modulators: OR 2.89, 95%CI for OR (1.16–7.20); 3 altered HD modulators: OR 1.67, 95%CI for OR (0.67–4.33); 4 altered HD modulators: OR 2.54, 95%CI for OR (1.04–6.25). Only 20.5% of hypertensive patients with a hyperinotropism pattern were treated with beta-blockers, only 41,4% of hypertensive patients with a vasoconstriction pattern were receiving vasodilatator drugs and only 1,4% of hypervolemic hypertensives were receiving diuretics. Conclusions: Hypertensive patients have a multitude of different HD profile patterns, which emphasizes the need of assessing their HD characteristics before choosing the more appropriate antihypertensive drug. Currently, antihypertensive treatment targets are unrelated to the HD profile. This may lead to hemodynamic imbalance and lack of optimal BP control due to choice of drugs unable to match the individual patient's HD profile.