HAEMODYNAMICALLY-GUIDED SELECTION OF THERAPY IMPROVES BLOOD PRESSURE CONTROL EFFICIENTLY IN PRIMARY CARE

Objective: Despite the availability of multiple classes of blood pressure (BP) lowering medications and numerous guidelines, BP control remains poor worldwide. The use of impedance cardiography (ICG) to determine haemodynamic measurements has been used in several trials to guide BP medication selection and improve BP control. We sought to improve BP control rates by selecting medications based on an individual patient’s haemodynamic profile and sharing this information with patients and providers to increase engagement.Design and method: From 2014 - 2023, patients diagnosed with hypertension and BP >=140/90 mmHg had ICG performed to determine three haemodynamic types. Vasoconstriction (high total peripheral resistance index) Hyperdynamic (high heart rate or high stroke index) Mixed Haemodynamic (combination of above) Medication recommendations were tailored to an individual patient’s haemodynamic type. Printed reports were shared with patients. Rates of BP control to <140/90 mmHg and number of office visits to attain BP control were followed. Results: In two large primary care organizations, 14,698 patients treated for hypertension but with a BP >=140/90 mmHg had an ICG performed. Of 22,346 ICGs completed, haemodynamic types were: 47% Vasoconstriction 24% Hyperdynamic 29% Mixed Haemodynamic Clinic 1: 8,489 patients were treated from 2014-2023, obtaining >92% average BP control rate. This control rate has been sustained for 10 years. BP control rate was obtained within 1.4 office visits on average. Clinic 2: 6,209 patients were treated from 2019-2023, obtaining >85% average BP control rate. BP control rate was obtained within 1.6 office visits on average. Conclusions: Less than half of patients with BP >=140/90 mmHg have vasoconstriction as their sole haemodynamic abnormality. BP control rates improved greatly when therapeutic decisions were personalized to an individual’s haemodynamic profile. Sharing haemodynamic information with patients appears to increase engagement and medication adherence. Controlling BP in <2 office visits should decrease primary care workload, costs, and sequelae of uncontrolled hypertension.