FROM EMPIRICAL TO PATHOGENETIC CHOICE OF ANTIHYPERTENSIVE THERAPY: THE ROLE OF BIOIMPEDANCEMETRY

Background. The proportion of patients with arterial hypertension achieving target blood pressure remains low, largely due to the empirical nature of therapy selection that disregards the individual haemodynamic mechanism of blood pressure elevation.

Aim. To assess the clinical efficacy and safety of pathogenetically guided antihypertensive therapy based on haemodynamic phenotyping by bioimpedancemetry compared with the standard empirical approach.

Materials and methods. A prospective open-label randomized controlled trial enrolled 120 patients with grade I–II arterial hypertension, randomized 5:1 into the main group (n=100; bioimpedancemetry-guided therapy) and the control group (n=20; standard therapy). A reference group comprised 25 healthy individuals. Follow-up lasted 6 months.

Results. Marked haemodynamic heterogeneity was revealed: vasoconstrictive phenotype — 40.8%, mixed — 25.0%, hyperdynamic — 18.3%, hypervolemic — 15.8%. The systolic blood pressure reduction in the main group was 28.9±7.6 versus 18.1±9.4 mmHg (p<0.01); target blood pressure was achieved by 84.0% versus 55.0% (p<0.01); nor­malization of the haemodynamic profile — 66.0% versus 35.0% (p=0.006). Adverse events were less frequent (9.0% versus 25.0%; p<0.01).

Conclusion. Pathogenetically guided therapy based on bioimpedancemetry is superior to the empirical ap­proach in efficacy and safety.