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Simple, Noninvasive Hemodynamic Monitoring Improves Uncontrolled Hypertension


Presented by Tommaso Comotti, Italy

The findings of the BEtter Control of Blood Pressure in Hypertensive pAtients Monitored Using the HOTMAN® sYstem trial [BEAUTY; NCT01482364] of 153 patients has demonstrated the value of the simple and noninvasive monitoring of hemodynamic parameters in improving uncontrolled hypertension. The findings were reported by Tommaso Comotti, MD, Istituto Auxologico Italiano, Milan, Italy.

High blood pressure (BP) remains uncontrolled in up to 20% of those treated for hypertension [de la Sierra A et al. Hypertension 2011; Egan BM et al. Circulation 2011]. The ultimate control of drug-treated, but still uncontrolled, hypertension may require more and/or better-acting drugs [Redón J et al. J Hypertens 2010]. Poor adherence due to side effects is also a problem [Ceral J et al. Hypertens Res 2011; Gifford RW Hypertension 1988; Klein LE Hypertension 1988].

Another option for BP control is the use of an approach termed integrated hemodynamic management. The approach relies on the technique of thoracic electrical bioimpedance, which, by means of externally placed probes, measures the electrical resistance of the thorax to a high-frequency, very-low magnitude current. The method permits real-time hemodynamic measurements and the low current used reduces artefacts. The technology is commercially available as the HOTMAN® system (Hemo Sapiens, San Ramon, CA, USA).

The multicenter, prospective, randomized BEAUTY study trial was designed to explore whether drug selection based on integrated hemodynamic management would improve the hemodynamic status of patients with uncontrolled hypertension during a 6-month follow-up (n=76; patients also received usual hypertensive care; IHM Group), compared with drugs selected conventionally according to the 2007 European Society for Hypertension guidelines (n=77; Co-group). The primary endpoint of the study was the absolute change in daytime ambulatory systolic BP. Whether the drug-related changes in hemodynamic parameters are related to BP alterations and whether the improvements in hemodynamic and BP control reduced adverse effects were also assessed.

Hemodynamic status was assessed as worsened, stable, or improved based on comparison of values obtained at baseline and the final clinic visit. The 2 investigators were blind to patient randomization. Inclusion criteria were age 18 to 75 years, essential hypertension, sustained hypertension at the baseline visit (systolic BP >140 mmHg) and during ambulatory BP monitoring (daytime systolic BP >135 mmHg), treatment with ≥2 anti-hypertensive drugs, and signed informed consent.

Patients were monitored during 6 clinic visits (ambulatory BP monitoring, echocardiography, HOTMAN, and pulse wave velocity; not all performed at each visit) and also maintained a BP diary.

Overall, hemodynamic status of the integrated hemodynamic management group improved more (49% and 50%, according to both investigators) than the control group (27% and 29%, same order; p=0.038 and p=0.008, respectively). Joint improvement of hemodynamic status and BP was superior in the treatment group (42% and 43%) than the control group (22% and 23%; p=0.014 and p=0.030, respectively; Figure 1).

Drug selection according to the HOTMAN responses was associated with fewer investigator-assessed side effects (1.18±1.17) than the conventional drug selection process (1.91±2.09).

Data from the BEAUTY study show that the noninvasive HOTMAN approach is associated with more favourable hemodynamic changes in patients with uncontrolled hypertension, better joint control of hemodynamics and BP, and fewer side effects.



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