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The problems associated with current ("conventional") treatment of hypertension are described elsewhere. That source also has examples of correct management of hypertension, identifying it as a hemodynamic disorder, and the web site of the International Hemodynamic Society contains other examples.

The purpose of this discussion is to demonstrate the fallacy of conventional management of hypertension. The conventional management of hypertension, used world-wide today, just strives for reduction of arterial blood pressure into the normotensive range and ignores the effects of selected antihypertensive therapy on patient's hemodynamics. Conventional therapy selects antihypertensive drug according to certain algorithms or pharmacological manufacturers recommendation. However, when the incorrect antihypertensive drug reduces global blood flow and thus perfusion of tissues, the outward manifestations of a low flow state are currently explained as the side effects of the drug therapy. Clear manifestations of low flow state are dizziness, tiredness, sleep disorders, male impotence, infertility, digestive disorders, body temperature control problems,... The clinician needs to know and understand a patient's hemodynamics to select a patient-specific therapy, which produces normohemodynamic and normoperfusion state, absent of these undesirable effects. The philosophy "this new drug treats hypertension better" is hemodynamically incorrect. A drug, which produces normohemodynamic state in one patient, is contraindicated in another.

The example of a "successful" treatment of hypertension by conventional antihypertensive therapy and how the actual hemodynamics of the same patient looks like are described and discussed below; see Fig.2, Fig.3 and Fig.4. The hemodynamic assessment and management data have been acquired by HOTMAN ^® System.

Fig.1: An example of Monitoring Page of a correctly treated hypertensive patient, unrelated to discussion below. All his hemodynamic parameters are within their respective normal ranges: His arterial blood pressure is 138/74, corresponding to MAP = 95 Torr, i.e. normotension. SI = 49 ml/m2; i.e., normodynamic flow. CI = 2.8 l/min/m2; i.e. normoperfusion state. Fore detailed explanation of the Monitoring page, go to http://www.hemosapiens.com/monitscr.html

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Fig.2: Data of a patient considered to be treated "successfully" by a conventional therapy for hypertension: The Monitoring Page acquired by HOTMAN^® System (see Fig.3 below) was modified as to show above only the data, which would be available by conventional hypertensive assessment: S/D = 141/63 Torr, corresponding to MAP = 89 Torr; i.e., normotension; ECG recording is "normal." However, the patient reports tiredness, permanent fatigue and a difficulty of coping with daily activities.

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Fig.3: Hemodynamic assessment by HOTMAN^® System (Monitoring Page) of the same patient as in Fig.2 (data acquired June 7, 2006 at 20:29). In this case, her complete hemodynamics is shown: From all 16 parameters processed, the only parameter showing normal range is her blood pressure, which happens to be the only parameter measured today by conventional therapy. Her perfusion blood flow, CI = 1.7 l/min/m2 is about one half of normal value of 3.5 l/min/m2, explaining the reasons for fatigue reported in the footnote of Fig.2. You also can see that her parameters of contractility and left-ventricular performance are profoundly infranormal and her afterload is more than twice of normal value (i.e., systemic vasoconstriction). A better understanding of the relation between the hemodynamic causes (levels of hemodynamic modulators) and hemodynamic consequences (hemodynamic state) are explained at the Hemodynamic Management Page, Fig.4, below. For understanding the Hemodynamic Management Page data presentation format, click here.

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Fig.4: Hemodynamic Management Page data presentation format of the same data as in Fig.3 (June 7, 2006 at 20:29): Her 116% hypodynamic state @ normotension are caused by 58% hypervolemia, 164% hypoinotropy and 127% vasoconstriction. Her 109% hypochronotropy (109% hypoperfusion) explains the fatigue and difficulty of coping with daily activities. If you want to learn more about the new concepts of hemodynamic management, click here.

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These examples, hopefully, explained the need to change current inadequate philosophy of treating hypertension as a blood pressure disorder and starting to view it as a hemodynamic disorder. This change will lead to better outcomes and shorter duration of therapy. Since the "conventional" therapy usually adds another antihypertensive drug when the original choice does not produce normotension, the consequent adding and adding leads to multiple antihypertensive drugs used. This is irresponsible. In contrast, the responsible approach, represented by hemodynamic management, clearly identifies which drugs and in what titration they should be used. As a consequence, the hemodynamic management may reduce the number of drugs used and lead to major savings in treatment of this disorder, which afflicts over one third of mankind.