To analyze the hemodynamic profile of treated hypertensive patients without optimal blood pressure control and to evaluate the consequences of an anti-hypertensive treatment that do not properly address the hemodynamic profile of these patients.Design and method:
Fifty-one consecutive hypertensive patients treated with at least 2 anti-hypertensive drugs admitted to our department between February 2014-May 2015 for uncontrolled blood pressure (BP) (over 140/90mmHg) and who gave written consent to participate in the study were evaluated by 12 lead ECG (for LVH by Socolow-Lion criterion), standard trans-thoracic echocardiography by GE Vivid 7 (LVEF, transmitral Doppler Flow pattern, LA enlargement and LVH) and non-invasive hemodynamic evaluation by HOTMAN system (volemia, ionotropism, vasoactivity and chronotropism).Results:
Study sample had a mean age of 61.39 ± 13.3 years (range 32–89 years) with an equal gender distribution (30 males; 58.8% and 21 females; 41.2%). Mean values of BP and hemodynamic parameters were: SBP 152.59 ± 19.522 mmHg; DBP 88.27 ± 11.93 mmHg; MAP: 109.67 ± 12.930 mmHg; SI: 49.18 ± 20.73 ml/beat/m2; LSWI: 72.44 ± 31.88 g x m/m2; SSVRI: 208.37 ± 106.59 dyn x sec x cm -5 x m2.Results:
There were 6 different hemodynamic profiles (Figure 1) and 10 different patterns of altered hemodynamic modulators (Figure 2).Results:
Only one patient out of 51 was receiving appropriate anti hypertensive drug class according to its hemodynamic modulators. In their majority (70.6%) patients from the study sample were receiving inappropriate anti hypertensive drugs according to theirs hemodynamic modulators that negatively influenced at least 2 hemodynamic modulators.Results:
There was a direct positive association between the number of altered hemodynamic modulators during anti hypertensive drug treatment and an increased frequency of LVH and LV diastolic dysfunction (Figure 3).Conclusions:
Uncontrolled treated hypertensive patients have a wide variety of hemodynamic profiles with at least 2 altered hemodynamic modulators requiring therefore an individualized therapeutic approach.Conclusions:
Failure to address altered hemodynamic modulators by proper anti-hypertensive drug class results in more frequent sub-clinical target organ damage.