Ferrario Carlos M, Flack John M, Strobeck John E, Smits Gerard, Peters Celine
Hypertension and Vascular Research Center, Wake Forest University Medical Center, Winston-Salem, North Carolina, USA.
Ther Adv Cardiovasc Dis. 2010 Feb;4(1):5-16. doi: 10.1177/1753944709348236. Epub 2009 Dec 30.
Hypertension affects 73 million Americans and costs the US healthcare system over $73 billion annually. Despite increasing awareness of the consequences of uncontrolled hypertension, numerous antihypertensive pharmacologic clinical studies and consistent updates to hypertension guidelines, control rates are suboptimal and have not met national goals. Among treated hypertensives, only 45% of women and 51% of men have reached blood pressure (BP) levels below 140/90 mmHg. Individualization of antihypertensive regimens with hemodynamic information from impedance cardiography (ICG) has been advocated to further improve hypertension control rates. We therefore undertook a quantitative analysis of the trials evaluating the role of ICG as an adjunct to therapeutic decision-making in the treatment of hypertension and the attainment of BP control.
Five studies comprising a total population of 759 patients met the inclusion criteria. Two randomized controlled trials (RCTs) involving a total of 268 patients and three single-arm prospective trials with 491 patients were evaluated using ICG data to guide therapeutic decision-making in the treatment of hypertensive patients.
Significant benefit was found in both RCTs for ICG-guided BP treatment. The combined odds ratio for the two trials was 2.41 (95% CI = 1.44-4.05, p = 0.0008), in favor of ICG treatment, meaning that it was more than twice as likely to achieve BP success when using ICG than if ICG was not used. Success attainment of goal BP of <140/90 mmHg was 67% in the ICG-guided arms of the combined randomized trials. Overall success in the single-arm prospective trials of ICG-guided BP treatment was a similar 68%.
The results of this meta-analysis confirm the value of using ICG-derived hemodynamic data as an adjunct to therapeutic decision-making in the treatment of hypertension. The data reviewed here demonstrate that ICG-based approaches are in keeping with previously advocated strategies incorporating patient-individualized drug regimens, evidence-based medicine, and practical, easy to apply, cost-effective principles to further improve hypertension control rates.
高血压影响着7300万美国人，美国医疗系统每年为此花费超过730亿美元。尽管人们越来越意识到未控制的高血压的后果，开展了大量抗高血压药物临床研究且高血压指南也不断更新，但控制率仍不理想，未达到国家目标。在接受治疗的高血压患者中，只有45%的女性和51%的男性血压（BP）水平降至140/90 mmHg以下。有人主张利用来自阻抗心动图（ICG）的血流动力学信息对抗高血压治疗方案进行个体化，以进一步提高高血压控制率。因此，我们对评估ICG在高血压治疗中作为辅助治疗决策及实现血压控制方面作用的试验进行了定量分析。
五项研究共纳入759例患者，符合纳入标准。两项随机对照试验（RCT）共涉及268例患者，三项单臂前瞻性试验共491例患者，利用ICG数据指导高血压患者的治疗决策。
在两项RCT中，ICG指导的血压治疗均显示出显著益处。两项试验的合并比值比为2.41（95%CI = 1.44 - 4.05，p = 0.0008），支持ICG治疗，这意味着使用ICG时实现血压达标的可能性是不使用ICG时的两倍多。在合并随机试验的ICG指导组中，血压目标值<140/90 mmHg的达标率为67%。ICG指导的血压治疗单臂前瞻性试验的总体达标率类似，为68%。
这项荟萃分析的结果证实了利用ICG得出的血流动力学数据作为高血压治疗辅助决策的价值。此处回顾的数据表明，基于ICG的方法符合先前倡导的策略，即采用患者个体化药物治疗方案、循证医学以及实用、易于应用且具有成本效益的原则，以进一步提高高血压控制率。
