A randomized and controlled study of noninvasive hemodynamic monitoring as a guide to drug treatment of uncontrolled hypertensive patients

• Published in: Journal of hypertension Vol. 33; no. 12; p. 2534
• Main Authors: Fadl Elmula, Fadl Elmula M, Rebora, Paola, Talvik, Anneli, Salerno, Sabrina, Miszkowska-Nagórna, Eliza, Liu, Xiaoqiu, Heinpalu-Kuum, Marika, Comotti, Tommaso, Larstorp, Anne C, Rostrup, Morten, Świerblewska, Ewa, Valsecchi, Maria Grazia, Kjeldsen, Sverre E, Viigimaa, Margus, Narkiewicz, Krzysztof, Parati, Gianfranco, Laurent, Stéphane
• Format: Journal Article
• Language: English
• Published: England 01.12.2015
• Subjects: Adult; Algorithms; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Clinical Decision-Making; Decision Support Techniques; Diuretics - therapeutic use; Female; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Male; Middle Aged; Prospective Studies
• ISSN: 1473-5598
• DOI: 10.1097/HJH.0000000000000749

In the BEtter control of BP in hypertensive pAtients monitored Using the HOTMAN sYstem study, we investigated whether utilizing noninvasive monitoring of hemodynamic parameters combined with a drug selection algorithm (integrated hemodynamic management - IHM) compared with conventional drug selection may improve uncontrolled hypertension in European Hypertension Excellence centers. Uncontrolled (office SBP >140 mmHg and ambulatory daytime SBP >135 mmHg while taking ≥2 antihypertensive drugs) essential hypertensive patients were referred to five European Hypertension Excellence centers and, if eligible, were randomized to IHM-guided (n = 83) vs. conventional (control, n = 84) treatment adjustment in an investigator-initiated multicenter prospective randomized parallel groups controlled study. The average number of antihypertensive drugs increased from 3.1 to 4.1 in both groups and differed only in a rise of the use of diuretics in the IHM groups (from 13 to 31%). Daytime SBP, defined as the primary endpoint, decreased markedly and to the same extent from baseline to 6 months in IHM (-15.8 ± 14.8 mmHg) and control (-15.4 ± 14.5 mmHg) groups (P = 0.87), with a similar behavior of office SBP (no between group differences, P = 0.18). Average number of adverse events was significantly lower in IHM than in controls (P = 0.008) but of the more general type and not necessarily related to drug treatment. Thus, noninvasive hemodynamic monitoring associated with a drug selection algorithm induced similar reductions in ambulatory daytime and office SBP compared with conventional drug selection in uncontrolled hypertensive patients referred to European Hypertension Excellence centers.Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT01482364.