IJCS | Volume 32, Nº1, January/ February 2019

66 Leão and Silva Impedance cardiography and hypertension Int J Cardiovasc Sci. 2019;32(1)61-69 Review Article necessary to evaluate the hemodynamic variables to be able to target the therapy at a high cardiac or SVR index. Likewise, if any of these parameters is decreased, the drug responsible for the effect should be identified, its dose reduced, or the drug withdrawn (Figure 4). 10,25,44,45 Several studies have highlighted the apparent superiority – although never assessed in long-term studies – of the personalized therapeutic approach to the hemodynamic profile, both regarding its efficacy and cost-effectiveness (Table 2). Conclusion Hemodynamic-guided therapy can be valuable in the evaluation and management of hypertensive patients. Impedance cardiography is a cost-effective assessment that allows the diagnosis, therapeutic optimization, and follow-up of hypertensive patients, helping them to achieve therapeutic targets, even in those with resistant hypertension. This therapeutic approach, which focuses on the cause of blood pressure increase and its pathophysiological mechanism, allows better blood pressure control and a potential reduction in cardiovascular events, mortality and costs associated with arterial hypertension. Future studies in the ICG area should broaden our understanding of the pathophysiology and hemodynamic changes of arterial hypertension and demonstrate that early diagnosis and treatment of hemodynamic characteristics have a positive impact on patient outcomes, reducing morbidity and mortality associated with high blood pressure. Author contributions Conception and design of the research: Leão RN, Silva PM. Acquisition of data: Leão RN, Silva PM. Analysis and interpretation of the data: Leão RN, Silva PM. Writing of the manuscript: Leão RN, Silva PM. Critical revision of the manuscript for intellectual content: Leão RN, Silva PM. Supervision / as the major investigador: Leão RN. Figure 4 - Algorithm for choice of antihypertensive therapy guided by impedance cardiography. If the values do not correspond to the exposed criteria, the patient has a balanced profile. *If neither the cardiac index (CI) nor the systemic vascular resistance index (SVRI) are high, the therapy should be selected according to the highest parameter, within the normal range. TFC: total fluid content; BB: beta-blocker; DHP: dihydropyridine; CCB: calcium channel blocker; ACE inhibitors: angiotensin-converting enzyme inhibitor; ARA: angiotensin II receptor antagonist.