Usefulness of impedance cardiography in optimisation of antihypertensive treatment in patients with metabolic syndrome: a randomised prospective clinical trial.
BACKGROUND
The effective antihypertensive therapy is one of the main goals of treatment in metabolic syndrome (MS) because hypertensive patients with MS are of high cardiovascular risk. The impedance cardiography (ICG), as a modern technique of non-invasive haemodynamic monitoring, enables the evaluation of cardiac index (CI), thoracic fluid content (TFC) and systemic vascular resistance index (SVRI) and seems to be useful in clinical individual assessment of patients with MS.


OBJECTIVE
To estimate the effectiveness of the antihypertensive therapy based on ICG.


METHODS
The study involved 82 hypertensive patients with MS (57 men, age 45.5 ± 10.0 years), without any major chronic diseases. After the preliminary assessment including office blood pressure measurement (OBPM), ambulatory blood pressure monitoring (ABPM) and ICG, the subjects were randomised into two groups: empirical (GE) and treated with the use of haemodynamic evaluation by ICG (HD). The effect of the therapy was estimated at 3 months follow-up.


RESULTS
After 12 weeks the HD group was characterised by lower mean BP values in OBPM and ABPM, with statistical significance for night-time SBP (120.6 ± 9.1 vs 115.6 ± 8.2 mm Hg, p = 0.036). The use of ICG significantly increased the reduction of BP in OBPM - SBP (GE vs HD: change 10.7 vs 18.1 mm Hg, p = 0.012), DBP (8.9 vs 12.2 mm Hg, p = 0.037), and ABPM: in the 24-h period SBP (10.5 vs 16.7 mm Hg; p = 0.013) and day-time SBP (10.5 vs 17.2 mm Hg, p = 0.009). More patients in the HD group reached recommended BP control in OBPM (23.5 vs 36.6%, p = 0.222) and ABPM (23.5 vs 43.9%, p = 0.117).


CONCLUSIONS
The antihypertensive therapy guided by ICG increased the reduction of BP in patients with MS. The assessment of haemodynamic profile by ICG guarantees better choice of antihypertensive drugs and subsequently increases the chance of recommended BP control in patients with MS.
Department of Cardiology and Internal Diseases, Military Institute of Medicine, ul. Szaserów 128, Warsaw, Poland. pkrzesinski@wim.mil.pl
Paweł
P
Krzesiński
Grzegorz
G
Gielerak
Jarosław
J
Kowal
Katarzyna
K
Piotrowicz
D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D002307:Cardiography, Impedance; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies
D000959:Antihypertensive Agents