Central BP guided therapy – a promising approach to antihypertensive treatment in patients with arterial hypertension, type 2 diabetes, and chronic kidney disease

Aim

To compare two strategies of hypertension management based on either brachial (standard approach) or central aortic blood pressure (BP) (intervention) in patients with type 2 diabetes mellitus and chronic kidney disease G3.

Material and methods

Sixty patients were enrolled into the open-label prospective randomized study. We measured office brachial BP with a validated oscillometric device and conducted 24-hour ambulatory BP to monitor office central BP and 24-h brachial and central BP (BPLab Vasotens). All patients were treated with fixed-dose combinations of indapamide/perindopril arginine or amlodipine/indapamide/ perindopril arginine at different doses according to BP levels. Target brachial BP was <140/85 mmHg, whereas target aortic BP was determined according to ageand gender-specific reference values. The study duration was 6 months.

Results

At month 1, up-titration of antihypertensive therapy was required in 93% of patients in both groups. At month 3, treatment was intensified in 37% of patients from standard approach group and in 13% patients from intervention group (p=0.07). Median systolic BP decrease in standard and intervention groups was 27 and 25 mmHg for brachial BP, and 26 and 28 mmHg for aortic BP, respectively (p>0.05). At the end of the study, target BP was achieved in 93% and 97% of patients, respectively.

Conclusion

Despite similar drop in office brachial and aortic BP, aortic BP guided approach was associated with a trend to a faster achievement of target BP and less frequent use of the highest doses of antihypertensive drugs.

Key words

Arterial hypertension, chronic kidney disease, type 2 diabetes mellitus, central aortic blood pressure, antihypertensive therapy, fixed-dose combination.