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Kidney Week

Abstract: TH-OR47

Changes in Aortic Compliance During Individualized Hypertension Management in CKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Chait, Yossi, University of Massachusetts Amherst, Amherst, Massachusetts, United States
  • Nathanson, Brian Harris, OptiStatum, Longmeadow, Massachusetts, United States
  • Schneditz, Daniel, Medizinische Universitat Graz, Graz, Steiermark, Austria
  • 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

The prevalence of hypertension (HTN) in chronic kidney disease (CKD) patients ranges from 60% to 90% with up to 50% having drug resistant hypertension.

Methods

Using a prospective pragmatic CQI initiative, we evaluated the effectiveness of a novel hypertension management (Study) with standard care (Control) in a cohort of patients with uncontrolled hypertension with and without chronic kidney disease. A pre-determined Study group algorithm, guided by hemodynamic data obtained using noninvasive bioimpedance-derived stroke volume measurements, was used for selecting and titrating antihypertensive medications based on state: vasoconstricted, hyperdynamic, and mixed. Hypertensive patients were assigned to groups at baseline, then followed for 4-6 months (endpoint). Aortic compliance was computed as the ratio of stroke volume (SV) over central pulse pressure (PP).

Results

There were 73 patients in Study group and 20 in Control. Baseline demographics and BP were similar in both groups (Table 1). Individualized hemodynamic guided management resulted in significantly greater reductions in mean SBP (24.2 vs. 14.5 mmHg, p = 0.010), DBP (12.8 vs. 7.3 mmHg, p = 0.031), and a greater proportion of patients achieving target BP (57.5% vs. 25.0%, p = 0.010). This was associated with more normalization of physiology at endpoint in the Study group (68.5% vs. 35.0%, p = 0.006). The change in compliance (endpoint-baseline) was statistically different only in Study Group A (Table 2). The correlation between the change in compliance and the change in SV was significantly different between groups (p= 0.021). In contrast, the changes in central PP were similarly correlated in both groups.

Conclusion

Hypertension management is more effective when guided by hemodynamic state. Greater decrease in BP is strongly associated with both hemodynamics normalization and compliance improvement, with the latter associated with increase in SV.

Table 1: Baseline demographics and BP

Table 2: Compliance at Baseline and Endpoint

Funding

  • Commercial Support