American Society of Hypertension - 23rd Annual Scientific Meeting and Exposition, 2008

Abstract Number: 350091
Presenting Author: B. Bo Sramek
Department/Institution: International Hemodynamic Society, USA
Abstract Category: Blood Pressure Measurement/Monitoring
Keyword: Hypertension management

Treating Hypertension as a Hemodynamic Disorder
Results in Three-fold Improvement in Outcomes

B. Bo Sramek, Ph.D.superscript1*,
E. Badila, M.D.superscript2, D. Bartos, M.D.superscript2, C. Tirziu, M.D.superscript2 and S. Ghiorge, M.D.superscript2.
superscript1International Hemodynamic Society, USA
superscript2Emergency Hospital Bucharest, Bucharest, Romania
*ASH Member

Hypertension management methodology evolved over years as a result of many published studies. Current therapeutic goal is normotension and the effects of selected therapy on blood flow are not routinely evaluated and measured. Current therapy consists of administration of different antihypertensive drugs according to published guidelines. Such approach produces normotension in <28% of treated hypertensives. The remaining 72% remain uncontrolled hypertensives.

The noninvasive blood flow measurement has to be included in hypertension management and the therapeutic goal must consist of both normotension and normodynamic circulation (normal blood flow), i.e., the normohemodynamic goal. New findings in hemodynamics clearly define a bi-directional relationship between the measured hemodynamic state (i.e., MAP @ SI) and measured levels in three hemodynamic modulators (intravascular volume, inotropy and vasoactivity). Only a patient who is normovolemic, normoinotropic and normovasoactive can be normohemodynamic.

Utilizing these findings, the hemodynamic antihypertensive therapy:
identifies the percentage deviation in each of these three modulators from normal, and
(b) selects cardio- and vasoactive drugs and their titration as to produce normovolemia, normoinotropy and normovasoactivity.
When the identified cause of hypertension is hypervolemia, diuretics are used. When it is hyperinotropy, negative inotropes are used. When it is vasoconstriction, vasodilators, ACE Inhibitors or ARBs are used. And when it is a combination of several causes, a corresponding combination of vasoactive and cardioactive drugs is used.

The Emergency Hospital in Bucharest, Romania, utilized the HOTMAN® System (HEMO SAPIENS INC., USA), which has the per-beat hemodynamic management methodology implemented in its software, to treat 56 patients with uncontrolled hypertension. Their mean age was 56 + 7 years, gender distribution was 57.2% females and 42.8% males.
Their previous treatment by a conventional antihypertensive therapy used one antihypertensive drug in 14.2% of patients, two drugs in 64.3% of patients and 21.5% of patients were treated with more than three antihypertensive drugs.
The initial hemodynamic assessment produced the following distribution of their hemodynamic causes:
(1) 82.1% hypervolemia, 17.9% normovolemia,
(2) 37.5% hyperinotropy, 62.5% normoinotropy,
(3) 67.9% vasoconstriction, 32.1% normovasoactivity.

Change in therapy was then instituted in 78.7% of patients, while 21.3% remained on existing therapy, though the drug titration was changed.
After 3 months, 84% of these uncontrolled hypertensives were normotensive and only 16% remained hypertensive. In addition, 87.5% reported no side effects.