A physiologic, precision-medicine approach to guided pharmacological treatment of hypertension substantially improves blood pressure in a large community-based cohort

Abstract

Abstract Background Worldwide blood pressure (BP) control rates remain poor. Hypertension (HTN) guidelines provide BP targets and recommend drug treatment algorithms but ignore the potential to treat the underlying haemodynamic reason. Patient’s poor adherence to medication is often identified as a potential cause of poor HTN control. Purpose To improve rates of BP control by matching patients’ non-invasive haemodynamics to specific pharmacologic treatments and increasing patient engagement. Methods 13,715 hypertensive patients were identified via the electronic medical record (EMR) from two US primary care groups between 2014 and 2023. Impedance Cardiography (ICG) was done when BP was >140/90. Physiologic measurements included blood pressure, mean arterial pressure, cardiac index, cardiac power index, total peripheral resistance index, stroke index and heart rate (Figure 1). HTN etiology was classified as: Vasoconstriction, Hyperdynamic, or Mixed pattern based on the haemodynamic findings of the ICG. Printed clinical decision support (CDS) tools and later an EMR integrated CDS application were used to communicate recommendations to physicians. Printed reports were shared with patients to increase their engagement. Rates of successful blood pressure treatment were tracked by analysis of EMR data. Results The demographics of 13,715 patients were 14% black, 50% women, 17% age 18-49, 45% age 50-69, and 38% age ≥ 70 years. A total of 21,246 ICGs were performed classifying patients as Vasoconstriction 46%, Hyperdynamic with high heart rate (HR) or high stroke index (SI) 25%, and Mixed Haemodynamic (combination of Vasoconstriction and Hyperdynamic) 29% (Figure 1). No demographic features predicted the physiologic grouping. 7,892 patients in the first cohort were treated from 2014 thru 2023 and obtained >90% BP control rate in 2016. This high control rate has been sustained for 6 years. 5,823 patients in the second cohort were treated from 2019 thru 2023 and obtained >86% BP control rate. Conclusions Haemodynamic data may help personalize anti-hypertensive therapy and improve control of HTN to >86-90%. Providing patients with insights about why their BP is high and providing rationale for selecting treatment may motivate their adherence and persistence with therapy. Hypertension physiology is not predicted by demographic features among patients managed in a primary care setting.Haemodynamic Status (ICG Test Results)