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

Fadl Elmula M Fadl Elmula, Paola Rebora, Anneli Talvik, Sabrina Salerno, Eliza Miszkowska-Nagórna, Xiaoqiu Liu, Marika Heinpalu-Kuum, Tommaso Comotti, Anne C. Larstorp, Morten Rostrup, Ewa ͆wierblewska, Maria Grazia Valsecchi, Sverre E. Kjeldsen, Margus Viigimaa, Krzysztof Narkiewicz, Gianfranco Parati, Stéphane Laurent

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2534-2545
Number of pages12
JournalJournal of Hypertension
Issue number12
Publication statusPublished - 2015


  • ambulatory blood pressure monitoring
  • antihypertensive drugs
  • blood pressure control
  • integrated hemodynamic monitoring
  • uncontrolled hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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