应用阻抗心动描记术对高血压进行“个体化”治疗：一项随机、前瞻性、对照试验。
A "patient-tailored" treatment of hypertension with use of impedance cardiography: a randomized, prospective and controlled trial.
机构信息
Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
出版信息
Med Sci Monit. 2013 Apr 5;19:242-50. doi: 10.12659/MSM.883870.
BACKGROUND
Arterial hypertension might be caused by hemodynamic disturbances such as fluid retention, increased vascular resistance, and hyperdynamic function of the heart. The aim of this study was to estimate the effectiveness of antihypertensive therapy based on hemodynamic assessment by impedance cardiography in a randomized, prospective, controlled trial.
MATERIAL AND METHODS
This study involved 128 patients (average age: 42.9 ± 11.1 years) with arterial hypertension, randomized into groups: (1) empiric, and (2) hemodynamic, in which treatment choice considered impedance cardiography results. Evaluation of treatment effects was performed after 12 weeks and included office blood pressure measurement and ambulatory blood pressure monitoring.
RESULTS
All final blood pressure values were lower in the hemodynamic group, significantly for office systolic blood pressure (empiric vs. hemodynamic: 136.1 vs. 131.6 mmHg; p=0.036) and diastolic blood pressure (87.0 vs. 83.7 mmHg; p=0.013), as well as night-time systolic blood pressure (121.3 vs. 117.2 mmHg; p=0.023) and diastolic blood pressure (71.9 vs. 68.4 mmHg; p=0.007). Therapy based on impedance cardiography significantly increased the reduction in office systolic blood pressure (11.0 vs. 17.3 mmHg; p=0.008) and diastolic blood pressure (7.7 vs. 12.2 mmHg; p=0.0008); as well as 24-h mean systolic blood pressure (9.8 vs. 14.2 mmHg; p=0.026), daytime systolic blood pressure (10.5 vs. 14.8 mmHg; p=0.040), and night-time systolic blood pressure (7.7 vs. 12.2 mmHg; p=0.032).
CONCLUSIONS
Antihypertensive treatment based on impedance cardiography can significantly increase blood pressure reduction in hypertensive patients.
背景
动脉高血压可能是由血流动力学紊乱引起的，如液体潴留、血管阻力增加和心脏高动力功能。本研究的目的是通过阻抗心动描记术评估血流动力学，在一项随机、前瞻性、对照试验中评估抗高血压治疗的效果。
材料和方法
这项研究涉及 128 名高血压患者（平均年龄：42.9±11.1 岁），随机分为两组：（1）经验性组，（2）血流动力学组，其中治疗选择考虑了阻抗心动描记术的结果。治疗效果的评估在 12 周后进行，包括诊室血压测量和动态血压监测。
结果
血流动力学组的所有最终血压值均较低，诊室收缩压（经验性 vs. 血流动力学：136.1 vs. 131.6mmHg；p=0.036）和舒张压（87.0 vs. 83.7mmHg；p=0.013），以及夜间收缩压（121.3 vs. 117.2mmHg；p=0.023）和舒张压（71.9 vs. 68.4mmHg；p=0.007）均有显著降低。基于阻抗心动描记术的治疗显著增加了诊室收缩压（11.0 vs. 17.3mmHg；p=0.008）和舒张压（7.7 vs. 12.2mmHg；p=0.0008）的降低，以及 24 小时平均收缩压（9.8 vs. 14.2mmHg；p=0.026）、日间收缩压（10.5 vs. 14.8mmHg；p=0.040）和夜间收缩压（7.7 vs. 12.2mmHg；p=0.032）的降低。
结论
基于阻抗心动描记术的抗高血压治疗可以显著降低高血压患者的血压。
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