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Kidney Week

Abstract: FR-PO1055

Impedance Cardiography-Guided Individualized Hypertension Treatment

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Chait, Yossi, University of Massachusetts, Amherst, Massachusetts, United States
  • Nathanson, Brian Harris, OptiStatim, LLC, Longmeadow, Massachusetts, United States
  • Greco, Barbara A., Renal and Transplant Associates of New England, Springfield, Massachusetts, United States
  • Germain, Michael J., Renal and Transplant Associates of New England, Springfield, Massachusetts, United States
Background

Current guidelines for management of hypertension (HTN) allow considerable leeway in selection of antihypertensive medications to achieve new lower blood pressure (BP) targets. Success in achieving target BP remains suboptimal. We observed BP outcomes under standard (standard) and individualized (modified) HTN treatment protocols.

Methods

We instituted a practice improvement project comparing standard to modified treatment protocols for the management of patients referred for resistant HTN with or without chronic kidney disease. The modified protocol, managed by two nephrologists, was centered around hemodynamic status: vasconstricted, hyperdynamic, or mixed state. Hemodynamic status was defined by impedance cardiography (central BP and pulse wave velocity were measured in a subset of patients). Antihypertensive medications were adjusted to treat the hemodynamic state. During an initial 6-month run-in, patients not in target BP were assigned to study groups. We compared BP outcomes using paired and unpaired t-tests at the study end.

Results

Of 169 patients at baseline, 88 continued with standard care and 81 were managed with the modified protocol. Demographics were similar in both groups. The modified group had significant reductions in both systolic BP and diastolic BP baseline to study end but the standard care group had little to no change (see Figure 1). At study end, 45.7% and 11.4% were in target BP in the modified and standard groups, respectively (p<0.001). This correlated with increased use of calcium channel blockers and beta-blockers in the modified group compared to standard care.

Conclusion

Impedance cardiography is a simple, noninvasive method for evaluating underlying hemodynamic drivers of HTN. Hypertension management is more effective when guided by hemodynamic parameters.

Box Plots of BP Outcomes by Study Group

Funding

  • Commercial Support