Individualni pristup terapiji arterijske hipertenzije putem impedansne kardiografije
Individual approach to hypertension treatment with use of impedance cardiography
Докторанд
Marjanović, MarijaМентор
Stojanov, VesnaЧланови комисије
Pavlović, SinišaMitrović, Predrag
Ristić-Anđelkov, Anđelka
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod: Mnoštvo opservacionih studija je pokazalo nezavisu i kontinuiranu povezanost visine
krvnog pritiska sa nastankom brojnih kardiovaskularnih događaja. Uprkos značajnom doprinosu
brojnih klasa antihipertenzivnih lekova, hipertenzija je nedovoljno kontrolisana u kliničkoj praksi,
kako u Evropi tako i širom sveta. Lekari obično nemaju mogućnost da ispitaju hemodinamske
osnove hipertenzije (hipervolemija, hiperinotropija ili vazokonstrikcija - ili kombinacija ovih
poremećaja). Stoga se izbor antihipertenzivne terapije često vrši nezavisno od hemodinamskog
statusa pacijenta. Precizna hemodinamska procena ranije je bila moguća jedino pomoću
invazivnih metoda, a u poslednje vreme ova procena se vrši putem neinvazivne impedansne
kardiografije.
Cilj: Glavni cilj ove studije je da se uporede efekti antihipertenzivne terapije bazirane na
hemodinamskim parametrima u odnosu na terapiju ordiniranu na osnovu kliničkih karakteristika
odnosno važećih preporuka.
Metode: Studija je obuhvatila 181 pac...ijenta sa stepenom 1 (140-159 mmHg) i stepenom 2 (160-
179 mmHg) esencijalne arterijske hipertenzije i sprovedena u Multidisciplinarnom centru za
polikliničku dijagnostiku, ispitivanje i lečenje poremećaja krvnog pritiska Klinike za kardiologiju
Univerzitetskog kliničkog centra Srbije u periodu od 01.04.2021 do 30.12.2021 godine. Podaci o
pacijentima su sakupljeni prospektivno i uneti u jedinstvenu elektronsku bazu podataka. Pacijenti
su randomizovani u odnosu 1:1 na: (1) empirijsku grupu, u kojoj je izbor lekova baziran na
kliničkim karakteristikama pacijenta prema važećim evropskim preporukama i (2) hemodinamsku
grupu, u kojoj je izbor lekova baziran na hemodinamskim parametrima dobijenim putem
impedansne kardiografije, pored kliničkih karakteristika. Posle 12 sedmica od početka terapije
vršeno je kontrolno merenje krvnog pritiska u ordinaciji, 24-ambulatorni monitoring krvnog
pritiska i impedansna kardiografija. Efekti primenjene terapije u obe terapijske grupe su analizirani
i statistički upoređeni korišćenjem Studentovog t testa, Man-Whitney-evog U testa i χ2-kvadrat
testa...
Title of doctoral dissertation: Individual approach to hypertension treatment with use of
impedance cardiography
Abstract
Background: Numerous observational studies have shown an independent and continuous link
between high blood pressure and a number of cardiovascular events. Despite the clear benefit of
numerous classes of antihypertensive therapy, hypertension remains poorly controlled in clinical
practice, either in Europe or worldwide. Physicians do not usually have the possibility of
evaluating the hemodynamic causes of the hypertension (hypervolemia, hyperinotropy or
vasoconstriction)-or whether there is a combination of these causes). Therefore, the choice of
antihypertensive is often made independent of the patient’s hemodynamic status. Formerly, such
hemodynamic information could only be obtained reliably using invasive measurement
techniques. Recently, the noninvasive technology of impedance cardiography as emerged as a
valuable new diagnostic tool.
Objective: The main objec...tive was to compare treatment effects of antihypertensive therapy based
on hemodynamic parameters and therapy according to the clinical characteristic and current
guidelines.
Methods: Our study obtained 181 patients diagnosed with grade 1 (140-159/90-99mmHg) and
grade 2 (160-179/100-109mmHg) essential arterial hypertension and was conducted at the
Multidisciplinary Centre for Polyclinic Diagnostics, Assessment and Treatment of Blood Pressure
disorders at the Clinic for Cardiology, University Clinical Center of Serbia between 01.04.2021.
and 30.12.2021. Patient data were collected prospectively and entered into a dedicated electronic
database. Patients were randomized in a 1:1 ratio to the: (1) empiric group in which treatment
choice was based on current guidelines and (2) hemodynamic group, in which treatment choice
was based on hemodynamic parameters established with impedance cardigraphy considering
clinical data. After 12 weeks of the beginning of therapy, control of examinations including office
blood pressure, 24-h ambulatory blood pressure monitoring and impedance cardiography were
performed. The groups and treatment effects were statistically compared by use of Student’s t test,
Man-Whitney U test and chi2 test...