THE AMERICAN SOCIETY OF HYPERTENSION

11th Scientific Meeting, New York, NY, 1996


NORMOHEMODYNAMIC GOAL-ORIENTED ANTIHYPERTENSIVE THERAPY IMPROVES THE OUTCOME

BB SramekSuperscript1, JA TichySuperscript2, M HojerovaSuperscript2, V CervenkaSuperscript2
Superscript1HEMO SAPIENSR-mark, Sedona, AZ, USA, and Superscript2The Institute for Preventive Care, Prague, Czech Republic

Normohemodynamic state involves a simultaneous normotension and normodynamic circulation. A noninvasive measurement of cardiac output and the hemodynamic management chart, which identifies the causes of abnormal hemodynamics (the percentage deviations in volume, inotropy, vasoactivity and chronotropy from their normal levels), were added to the noninvasive armament for treatment of hypertension and implemented into a computerized system (HOTMANR-mark System, HEMO SAPIENS INC., USA), used in the study. Instead of a conventional selection of antihypertensive drugs by trial-and-error, we were able to identify and administer such antihypertensive drug(s), which were optimal and specific for each patient.

383 randomly selected hypertensive patients (230 men and 153 women), previously treated by a conventional therapy of at least 2 antihypertensive drugs between 2 and 42 years (mean 12.5 years) were used in the study (see Fig.1 below). During the initial noninvasive hemodynamic assessment, 61 patients (15.9%) had their blood pressure within the normotensive range (MAP < 105 Torr) and were excluded from a further participation in the study. (This percentage is consistent with the 5th Report of Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, 1993, NIH.) The remaining patients covered mild, moderate and severe hypertension categories. 51 of these (15.9%) were hypodynamic hypertensives, 210 (65.2%) were normodynamic hypertensives and 61 (18.9%) were hyperdynamic hypertensives (see Fig.2 below). All these 322 hypertensives were then prescribed antihypertensive drugs, which generic categories were suggested by the System, as to aim for both normotension and normodynamic state.

All patients were measured again in approximately 3 weeks. Though normotension could not be achieved by a conventional antihypertensive therapy in any of these 322 patients, the normohemodynamic goal-oriented therapy produced normotension in 203 of them (63%). In addition, 242 patients (75%) became normodynamic (see Fig.3 below). This profound hemodynamic improvement took place in the first therapeutic intervention.

Key words: Outcome, hemodynamics, normohemodynamic goal

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HT-initial-1
Fig.1: The scattergram of hemodynamics (SI @ MAP) of all 383 hypertensive patients tested at the onset of the study.
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HT-322-1
Fig.2: After excluding the 61 patients who tested normotensive, this is the scattergram of hemodynamics of 322 patients who remained hypertensive in spite of using at least 2 antihypertensive drugs for at least 2 years.
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Fig.3: The scattergram of the same group of 322 patients after 3 weeks of a normohemodynamic goal-oriented therapy. 203 patients were normotensive and 242 were normodynamic.

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