Effect of routinely tailoring anti-hypertensive therapy to hemodynamic profile in primary care.

BACKGROUND AND PURPOSE: Controlling blood pressure (BP) reduces cardiovascular morbidity and mortality but is often not achieved in clinical practice. Tailoring therapy to an individual's hemodynamic profile using impedance cardiography (ICG) might attain efficient, effective BP control. METHODS: An observational study of hypertensive patients managed by two large U.S. primary care groups (PriMED and Premier) used therapeutic algorithms based on ICG-derived hemodynamics linked to clinical decision support tools to promote physician and patient engagement and medication adherence. The main outcome of interest was BP control according to contemporary (2014) guidelines (<140/<90 mmHg). A subset of PriMED patients was followed for six years, to evaluate clinical outcomes. Clinical information was extracted from electronic medical records. RESULTS: Of 14,058 patients, median (interquartile range (IQR)) age was 62 (51 to 71) years, 50% were women, and initial systolic and diastolic BP were 152 (145-162) mmHg and 90 (80-98) mmHg. The hemodynamic profile was vasoconstriction for 6,609 (47%) patients, hyperdynamic for 3,365 (24%) and mixed for 4,084 (29%). For PriMED, 92% achieved BP control at the second follow-up visit. For Premier, 81% achieved control at second follow-up, and 91% by the fourth visit, with annual control rates thereafter ranging from 82% to 93%. For 2,955 patients continuously managed by PriMED between 2016-2022, annual rates of myocardial infarction and stroke were 0.30% and 0.43%. CONCLUSIONS: Tailoring anti-hypertensive therapy according to hemodynamic profile in primary care is feasible, providing rapid and sustained BP control with low rates of myocardial infarction and stroke.