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April 13, 2021Open Access

Effectiveness of An Impedance Cardiography Guided Treatment Strategy to Improve Blood Pressure Control in A Real-World Setting: Results from A Pilot Pragmatic Clinical Trial

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Why the study?

Hypertension involves abnormalities of cardiac output and systemic vascular resistance, but whether selecting antihypertensive therapy based on hemodynamic profiles improves blood pressure control more than standard care in real-world practice was untested.

Does an impedance cardiography (ICG) guided treatment strategy improve blood pressure reduction compared to standard care in adults with uncontrolled hypertension?

Population

102 adults with uncontrolled hypertension seeking outpatient care in Beijing, China

Comparison

Impedance cardiography guided treatment vs standard care

Design

Pilot single-center pragmatic randomized trial

Follow-up

4-12 weeks

Key result

An impedance cardiography-guided treatment strategy significantly reduced systolic blood pressure by 19.9 mmHg compared to a 12.0 mmHg reduction with standard care in patients with uncontrolled hypertension.

Authors

LWLuyan WangYLYuan LuHWHongyi Wang

Discussion

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Member takes

Overview

Supports ICG-guided therapy for greater BP reductions in uncontrolled hypertension; extends evidence for hemodynamic tailoring in this pilot RCT.

Study Design

Type

RCT (n=102)

Blinding

Single-blind

Randomization

1:1

Multicenter

No

Structured PICO

Does an impedance cardiography (ICG) guided treatment strategy improve blood pressure reduction compared to standard care in adults with uncontrolled hypertension?

P
Population
102 adults (aged 18-85 years) with uncontrolled essential hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg) currently on 0 to 3 antihypertensive medications, mean age 54, 41% female, seeking outpatient care in Beijing, China. Excluded: >3 antihypertensive agents, secondary hypertension, severe renal disease, cancer, severe valvular disease, cerebrovascular event within 6 months, atrial fibrillation, or uncontrolled diabetes.
I
Intervention
Impedance cardiography (ICG) guided treatment strategy. Physicians were provided with patients' ICG findings and a computerized clinical decision support tool recommending treatment choices based on four hemodynamic phenotypes (cardiac, arterial vascular, peripheral vascular, and volemic).
C
Comparator
Standard care. Physicians were not provided with ICG findings and used their own clinical judgement to make treatment decisions. Both groups received education on medication compliance.
O
Outcome
Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline to the follow-up visit at 4-12 weeks.surrogate

Main Result

Absolute Event Rate: 19.9% vs 12%

p-value: p=<0.001

An impedance cardiography-guided treatment strategy significantly improved systolic and diastolic blood pressure reductions compared to standard care in outpatients with uncontrolled hypertension.

Limitations

  • Pilot study with limited number of participants and relatively short follow-up
  • Conducted in a Chinese population, so results may not be generalizable to other populations
  • Did not assess medication compliance among hypertensive patients

Cite This Study

Wang et al. (2021) conducted an RCT in Uncontrolled hypertension (n=102). Impedance cardiography (ICG) guided treatment strategy vs. Standard care was evaluated on Change in systolic blood pressure (SBP) from baseline (p=<0.001). An impedance cardiography-guided treatment strategy significantly reduced systolic blood pressure by 19.9 mmHg compared to a 12.0 mmHg reduction with standard care in patients with uncontrolled hypertension.

synapsesocial.com/papers/6a1db4ca9df5fa36af4da7c0https://doi.org/10.1101/2021.04.09.21255233
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