title: Identification of the hemodynamic modulators and hemodynamic status in uncontrolled hypertensive patients.
abstract: Only 20-30% out of the treated hypertensive patients in Europe are achieving blood pressure (BP) control. Among other recognized factors, these poor results could be attributable to the fact that for many doctors it is very difficult to detect which is the predominant hemodynamic cause of the hypertension (hypervolemia, hyperinotropy or vasoconstriction). The aim of the study was to use non-invasive thoracic electrical bioimpedance (TEB) to evaluate hemodynamic modulators and subsequent hemodynamic status in uncontrolled hypertensive patients, receiving at least two antihypertensive drugs. A number of 134 uncontrolled hypertensive patients with essential hypertension were evaluated in nine European Hypertension Excellence centers by means of TEB (the HOTMAN(®) System). Baseline office systolic and diastolic BP averaged 156/92 mmHg. Hemodynamic measurements show that almost all patients (98.5%) presented at least one altered hemodynamic modulator: intravascular hypervolemia (96.4%) and/or hypoinotropy (42.5%) and/or vasoconstriction (49.3%). Eleven combinations of hemodynamic modulators were present in the study population, the most common being concomitant hypervolemia, hypoinotropy and vasoconstriction in 51(38%) patients. Six different hemodynamic states (pairs of mean arterial pressure and stroke index) were found. Data suggest that there is a strong relation between hypertension and abnormal hemodynamic modulators. This method might be helpful for treatment individualization of hypertensive patients.
authors.affiliation: Tallinn University of Technology, Centre of Cardiology, North Estonia Medical Centre , Estonia.
authors.forename: M
authors.initials: M
authors.lastname: Viigimaa
authors.forename: A
authors.initials: A
authors.lastname: Talvik
authors.forename: W
authors.initials: W
authors.lastname: Wojciechowska
authors.forename: K
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.forename: I
authors.initials: I
authors.lastname: Toft
authors.forename: G S
authors.initials: GS
authors.lastname: Stergiou
authors.forename: E G
authors.initials: EG
authors.lastname: Nasothimiou
authors.forename: V
authors.initials: V
authors.lastname: Kotsis
authors.forename: E
authors.initials: E
authors.lastname: Agabiti Rosei
authors.forename: M
authors.initials: M
authors.lastname: Salvetti
authors.forename: M
authors.initials: M
authors.lastname: Dorobantu
authors.forename: N
authors.initials: N
authors.lastname: Martell-Claros
authors.forename: M
authors.initials: M
authors.lastname: Abad-Cardiel
authors.forename: R
authors.initials: R
authors.lastname: Hernández-Hernández
authors.forename: M
authors.initials: M
authors.lastname: Doménech
authors.forename: A
authors.initials: A
authors.lastname: Coca
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D000075222:Essential Hypertension; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000378:metabolism* / Q000503:physiopathology; D008297:Male
chemical_list: D000959:Antihypertensive Agents