Individualni pristup terapiji arterijske hipertenzije putem impedansne kardiografije

Abstract

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 pacijenta 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 objective 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...