Poster manejo hemodinamico hipertensión arterial. Congreso IFAD - Belgica.
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2017. Poster manejo hemodinamico hipertensión arterial. Congreso IFAD - Belgica. International Fluid Academy (IFAD) congress Belgium 2017.
![Hemodynamic Management of High Blood Pressure
Chacón-Lozsán F*1, Rodriguez-Torres M2, Rojas R3.
1. Critical care resident at Caracas University Hospital, European Society of CardiologyCouncil on Hypertension.
2. Pediatrics resident at Caracas University Hospital.
3. Nephrologist, Intensivist at Caracas University Hospital.
Background: Hypertension is an important risk factor for
cardiovascular events, stroke and kidney disease, optimal
hypertension control still a controversial subject in medical
literature, several studies proposed the hypertension
control calculating hemodynamic parameters.
Materials and Methods: In the present study we recruited
84 patients’ males (34%) and females (49%) between 32
and 95 years of age with non-controlled hypertension
taken 2 or more medications and measured heart rate (HR),
systolic (SBP), diastolic (DBP) and mean (MAP) blood
pressure, pulse pressure (PP), cardiac index (CI) using
Liljestrand & Zander modified formula to calculate stroke
volume (CI=[HR*(PP/MAP)] / Body surface area), central
venous pressure (CVP) using inferior vena cava diameter
(IVCD), systemic vascular resistance index
Group SVRi CI CVP Treatment
Hyperdynamic Normal >3,5L/min/m2 Normal Selective B-Blocker
High Resistance >2500dynes/sec/m2/cm-5. Normal Normal Nondihynopyridine calcium channel
blocker
Fluid overload Normal Normal >8cmH2O Diuretic
Hyperdynamic + high
resistance
>2500dynes/sec/m2/cm-5. >3,5L/min/m2 Normal Selective B-Blocker
+ Nondihynopyridine calcium channel
blocker
Hyperdynamic + Fluid
overload
Normal >3,5L/min/m2 >8cmH2O Selective B-Blocker + Diuretic
High Resistance + fluid
overload
>2500dynes/sec/m2/cm-5. Normal >8cmH2O Nondihynopyridine calcium channel
blocker + Diuretic
GROUPSAND INTERVENTION
Hyperdynamic group High resistance group
RESULTS
Variable All Hd Hr Hd+Hr Hd+FO Hr+FO
n 84 5 22 5 15 37
Age years
(mean ± SD)
62,3±14,7 51,2±10,9 63,2±14,1 58,4±15,2 64,4±16,5 63±13,9
Male
(n/%)
34/41 0/0 5/22,8 2/40 7/47 18/49
Female
(n/%)
49/59 5/100 17/77,2 3/60 8/53 19/51
BMI
(mean ± SD)
25,4±4,8 24,1±3,6 25,5±4,1 25,8±4,6 23,1±2,9 26,9±5,3
BSA
(mean ± SD)
1,7±0,2 1,5±0,08 1,7±0,2 1,6±0,08 1,5±0,1 1,7±0,2
Basal HR
(mean ± SD)
83,2±16,4 94,4±24,3 81,2±12,4 93,8±12,2 92,8±18 78,5±14,7
Final HR
(mean ± SD)
73±6,8 73,6±5,5 73,8±6,2 75,6±4,8 73,9±7,9 71,4±7
Basal SBP
(mean ± SD)
178,6±23,5 177,6±21,1 170,6±21,8 186,8±23 178,9±14,5 183,6±27
Final SBP
(mean ± SD)
127,5±4,8 128,4±3,8 127±4,4 125,2±5,3 126,9±5,1 128,4±5
Basal DBP
(mean ± SD)
99,9±16,4 88,4±18,5 103±12,6 102,6±14,2 67,7±8,6 106,2±16
Final DBP
(mean ± SD)
66,4±4,6 65,8±2,9 65,2±3,9 68±2,1 67,6±5,1 65,2±5,3
Basal MAP
(mean ± SD)
126,2±16,7 118,2±18,1 125,5±14,4 130,6±17,1 118,1±7,9 131±17,3
Final MAP
(mean ± SD)
86,7±3,9 86,8±2,3 85,9±3,3 87,2±2,3 87,4±4,5 86,2±4,6
Basal CI
(mean ± SD)
3,09±1,07 4,4±0,6 2,5±0,5 3,5±0,08 4,4±0,6 2,5±0,2
Final CI
(mean ± SD)
3,02±0,41 3,2±0,15 3±0,4 2,9±0,3 3,1±0,2 2,9±0,3
Basal SVRi
(mean ± SD)
3543±1553 2079±297,7 4029±962,4 2814±361,6 2020±305,9 4160±1558
Final SVRi
(mean ± SD)
2191±325,6 1969±240,3 2153±313,9 2231±185,1 2080±209,5 2200±260,1
Basal CVP
(mean ± SD)
9,3±4,0 5,6±1,3 5,7±1 6,2±0,8 10,6±2,9 12±3,5
Final CVP
(mean ± SD)
7,2±1,2 6±1 6,1±0,9 6,4±0,8 6,2±0,6 6,2±0,6
Conclusion: Hemodynamic guided treatment to
control high blood pressure had good results in this
study; however, bigger trials are needed to prove his
efficacy.
(SVRi=MAP/CI*80) and divided in six hemodynamic groups:
Hyperdynamics (Hd) were those with CI>3,5L/min/m2, High
Resistance (Hr) group when SVRi>2500dynas, Fluid
overload (FO) whenCVP>8cmH2O or IVCD>2cm and mixed
types, Hd+Hr, Hd+FO and Hr+FO, a basal values was
measured after 1 week washout with captopril, after
washout treatment was selected according hemodynamic
groups with a 6 months follow up.
Results: We found a statistical significant reduction of all
parameters at the first month after treatment and
hypertension control according European of Society
Cardiology guidelines in 100% of patients at 3th month of
treatment with hemodynamic normalization, only Hd+FO
at 6th month, with no symptomatic hypotension.
©2017 Francisco José Chacón Lozsán M.D (franciscojlk@hotmail.com)
Keywords: hypertension, hemodynamics, high blood pressure, cardiac index, vascular resistance.](https://image.slidesharecdn.com/revisedpostermanejohemodinamicohtaifadbelgica5b25d-180516193513/85/Poster-manejo-hemodinamico-hipertension-arterial-Congreso-IFAD-Belgica-1-320.jpg)
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Poster manejo hemodinamico hipertensión arterial. Congreso IFAD - Belgica.
- 1. Hemodynamic Management of High Blood Pressure Chacón-Lozsán F*1, Rodriguez-Torres M2, Rojas R3. 1. Critical care resident at Caracas University Hospital, European Society of CardiologyCouncil on Hypertension. 2. Pediatrics resident at Caracas University Hospital. 3. Nephrologist, Intensivist at Caracas University Hospital. Background: Hypertension is an important risk factor for cardiovascular events, stroke and kidney disease, optimal hypertension control still a controversial subject in medical literature, several studies proposed the hypertension control calculating hemodynamic parameters. Materials and Methods: In the present study we recruited 84 patients’ males (34%) and females (49%) between 32 and 95 years of age with non-controlled hypertension taken 2 or more medications and measured heart rate (HR), systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure, pulse pressure (PP), cardiac index (CI) using Liljestrand & Zander modified formula to calculate stroke volume (CI=[HR*(PP/MAP)] / Body surface area), central venous pressure (CVP) using inferior vena cava diameter (IVCD), systemic vascular resistance index Group SVRi CI CVP Treatment Hyperdynamic Normal >3,5L/min/m2 Normal Selective B-Blocker High Resistance >2500dynes/sec/m2/cm-5. Normal Normal Nondihynopyridine calcium channel blocker Fluid overload Normal Normal >8cmH2O Diuretic Hyperdynamic + high resistance >2500dynes/sec/m2/cm-5. >3,5L/min/m2 Normal Selective B-Blocker + Nondihynopyridine calcium channel blocker Hyperdynamic + Fluid overload Normal >3,5L/min/m2 >8cmH2O Selective B-Blocker + Diuretic High Resistance + fluid overload >2500dynes/sec/m2/cm-5. Normal >8cmH2O Nondihynopyridine calcium channel blocker + Diuretic GROUPSAND INTERVENTION Hyperdynamic group High resistance group RESULTS Variable All Hd Hr Hd+Hr Hd+FO Hr+FO n 84 5 22 5 15 37 Age years (mean ± SD) 62,3±14,7 51,2±10,9 63,2±14,1 58,4±15,2 64,4±16,5 63±13,9 Male (n/%) 34/41 0/0 5/22,8 2/40 7/47 18/49 Female (n/%) 49/59 5/100 17/77,2 3/60 8/53 19/51 BMI (mean ± SD) 25,4±4,8 24,1±3,6 25,5±4,1 25,8±4,6 23,1±2,9 26,9±5,3 BSA (mean ± SD) 1,7±0,2 1,5±0,08 1,7±0,2 1,6±0,08 1,5±0,1 1,7±0,2 Basal HR (mean ± SD) 83,2±16,4 94,4±24,3 81,2±12,4 93,8±12,2 92,8±18 78,5±14,7 Final HR (mean ± SD) 73±6,8 73,6±5,5 73,8±6,2 75,6±4,8 73,9±7,9 71,4±7 Basal SBP (mean ± SD) 178,6±23,5 177,6±21,1 170,6±21,8 186,8±23 178,9±14,5 183,6±27 Final SBP (mean ± SD) 127,5±4,8 128,4±3,8 127±4,4 125,2±5,3 126,9±5,1 128,4±5 Basal DBP (mean ± SD) 99,9±16,4 88,4±18,5 103±12,6 102,6±14,2 67,7±8,6 106,2±16 Final DBP (mean ± SD) 66,4±4,6 65,8±2,9 65,2±3,9 68±2,1 67,6±5,1 65,2±5,3 Basal MAP (mean ± SD) 126,2±16,7 118,2±18,1 125,5±14,4 130,6±17,1 118,1±7,9 131±17,3 Final MAP (mean ± SD) 86,7±3,9 86,8±2,3 85,9±3,3 87,2±2,3 87,4±4,5 86,2±4,6 Basal CI (mean ± SD) 3,09±1,07 4,4±0,6 2,5±0,5 3,5±0,08 4,4±0,6 2,5±0,2 Final CI (mean ± SD) 3,02±0,41 3,2±0,15 3±0,4 2,9±0,3 3,1±0,2 2,9±0,3 Basal SVRi (mean ± SD) 3543±1553 2079±297,7 4029±962,4 2814±361,6 2020±305,9 4160±1558 Final SVRi (mean ± SD) 2191±325,6 1969±240,3 2153±313,9 2231±185,1 2080±209,5 2200±260,1 Basal CVP (mean ± SD) 9,3±4,0 5,6±1,3 5,7±1 6,2±0,8 10,6±2,9 12±3,5 Final CVP (mean ± SD) 7,2±1,2 6±1 6,1±0,9 6,4±0,8 6,2±0,6 6,2±0,6 Conclusion: Hemodynamic guided treatment to control high blood pressure had good results in this study; however, bigger trials are needed to prove his efficacy. (SVRi=MAP/CI*80) and divided in six hemodynamic groups: Hyperdynamics (Hd) were those with CI>3,5L/min/m2, High Resistance (Hr) group when SVRi>2500dynas, Fluid overload (FO) whenCVP>8cmH2O or IVCD>2cm and mixed types, Hd+Hr, Hd+FO and Hr+FO, a basal values was measured after 1 week washout with captopril, after washout treatment was selected according hemodynamic groups with a 6 months follow up. Results: We found a statistical significant reduction of all parameters at the first month after treatment and hypertension control according European of Society Cardiology guidelines in 100% of patients at 3th month of treatment with hemodynamic normalization, only Hd+FO at 6th month, with no symptomatic hypotension. ©2017 Francisco José Chacón Lozsán M.D (franciscojlk@hotmail.com) Keywords: hypertension, hemodynamics, high blood pressure, cardiac index, vascular resistance.