A randomized and controlled study of noninvasive hemodynamicmonitoring as a guide to drug treatment of uncontrolled hypertensive patients

Background: In the BEtter control of BP in hypertensive pAtients monitored Using the HOTMAN sYstem study, we investigated whether utilizing noninvasive monitoring of hemodynamic parameters combined with a drug selection algorithm (integrated hemodynamic management-IHM) compared with conventional drug selection may improve uncontrolled hypertension in European Hypertension Excellence centers. Method: Uncontrolled (office SBP >140 mmHg and ambulatory daytime SBP >135 mmHg while taking-2 antihypertensive drugs) essential hypertensive patients were referred to five European Hypertension Excellence centers and, if eligible, were randomized to IHM-guided (n=83) vs. conventional (control, n=84) treatment adjustment in an investigator-initiated multicenter prospective randomized parallel groups controlled study. Results: The average number of antihypertensive drugs increased from 3.1 to 4.1 in both groups and differed only in a rise of the use of diuretics in the IHM groups (from 13 to 31%). Daytime SBP, defined as the primary endpoint, decreased markedly and to the same extent from baseline to 6 months in IHM (-15.8±14.8 mmHg) and control (-15.4±14.5 mmHg) groups (P=0.87), with a similar behavior of office SBP (no between group differences, P=0.18). Average number of adverse events was significantly lower in IHM than in controls (P=0.008) but of the more general type and not necessarily related to drug treatment. Conclusion: Thus, noninvasive hemodynamic monitoring associated with a drug selection algorithm induced similar reductions in ambulatory daytime and office SBP compared with conventional drug selection in uncontrolled hypertensive patients referred to European Hypertension Excellence centers.