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Abstract

Use of impedance cardiography (ICG) can improve blood pressure (BP) control in resistant hypertension (HTN). The purpose of this study was to determine if ICG could aid primary care physicians in increasing BP control in mild to moderate HTN.

Patients (pts.) with uncontrolled HTN evidenced by systolic BP (SBP) of 140 - 179 mm Hg and/or diastolic BP (DBP) of 90 - 109 mm Hg on 1–3 anti-hypertensive medications were enrolled and randomized by a 3:2 sequence of standard care to ICG-guided care and stratified by site. Each pt. completed 5 study visits that included a 2-week washout followed by 3 months of active treatment. ICG data (BioZ ICG Monitor, CardioDynamics) including cardiac index (CI), systemic vascular resistance index (SVRI), and thoracic fluid content (TFC) were collected in both arms but only revealed in the ICG-managed arm.

164 pts. from 11 centers completed the study, 95 in the standard care and 69 in the ICG-managed arm. There were no differences in the standard care vs. ICG-managed arm in age (55 vs. 54 yrs), gender (54 vs. 55% male), race (79 vs. 77% white), and prevalence of diabetes (5 vs. 4%), ischemic heart disease (2 vs. 7%), or hyperlipidemia (16 vs. 17%). There were also no differences at the enrollment and post-washout visit in SBP (147 vs. 148 and 155 vs. 155 mm Hg), DBP (87 vs. 89 and 92 vs. 94 mm Hg), or number of anti-hypertensive meds (1.7 vs. 1.7 and 0.0 vs. 0.0). At enrollment, pts. in the standard care and ICG-managed arm had similar CI (2.9 vs. 2.9 L/min/m2), SVRI (2,873 vs. 2,933 dyne sec m2 cm−5), and TFC (28.6 vs. 28.5 /kOhm). At the final visit, pts. in the ICG-managed care arm had a lower SBP (129 vs. 137 mm Hg, p<0.01) and DBP (78 vs. 82 mm Hg, p<0.05), greater drop in SBP (19 vs. 11 mm Hg, p<0.01) and DBP (11 vs. 5 mm Hg, p<0.001), and higher rates of BP control to < 140/90 mm Hg (78 vs. 55%, p<0.01) and 130/85 mm Hg (55 vs. 29%, p<0.01). Pts. in the ICG-managed care arm had no differences in the number of anti-hypertensive meds (2.1 vs. 2.0) although more were on angiotensin II receptor blockers (52 vs. 32%, p<0.05) and had a greater drop in SVRI (375 vs. 164 dyne sec m2 cm−5, p<0.05).

These data are the first to show that in pts. with mild to moderate HTN on 1 or more anti-hypertensive meds, ICG-guided therapy results in greater reductions in systolic and diastolic BP and increased BP control rates.

Hemodynamics, Hypertension, Impedance Cardiography
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© American Journal of Hypertension, Ltd. 2005
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