Haemodynamics in Hypertension (DYNAMIC)

• Change in haemodynamic variables during the follow-up [ Time Frame: baseline, one year, ten years ] [ Designated as safety issue: No ]
  Haemodynamic measurements are performed at baseline, after one year and after 10 years of follow-up
  
  

• Haemodynamic response to head-up tilt and research drugs [ Time Frame: 0, 5, 10, 15, 20, 25 and 30 minutes ] [ Designated as safety issue: No ]
  Rapid haemodynamic responses are assessed during the same measurement session (the response to head-up tilt and to research drugs salbutamol, nitroglycerin and L-arginine)
  
  
• Haemodynamic response to bisoprolol or dietary supplements (liquorice, milk casein-derived polypeptides) [ Time Frame: baseline and after 2 weeks (liquorice); 3 weeks (bisoprolol), or 12 weeks (polypeptides) ] [ Designated as safety issue: No ]
  The change in haemodynamic variables after daily consumption of liquorice (2 weeks); bisoprolol (3 weeks); small milk casein-derived polypeptides (12 weeks)
  
  

Elevated blood pressure (BP) and related cardiovascular complications are the leading causes of morbidity and mortality in the modern world. In routine clinical practice, the haemodynamic status is commonly assessed by measuring heart rate and blood pressure at rest, which provides only limited information about functional haemodynamic status. In addition, the haemodynamic changes resulting in similar elevations of BP may differ substantially between patients and disorders.

Therefore, we investigated the haemodynamic changes in primary and secondary hypertension and in the control subjects with non-invasive radial pulse wave analysis and whole-body impedance cardiography. The method includes the determination of peripheral and central BP, cardiac function, vascular resistance, arterial compliance and indices of pulse wave reflection. Besides the measurements performed in the supine position, passive orthostatic challenge is included to the protocol to assess functional haemodynamic status. In addition, the effects of single doses of two largely endothelium-dependent agents, inhaled salbutamol and intravenous L-arginine, and one endothelium-independent agent, sublingual nitroglycerin, were investigated. The repeatability and reproducibility of the protocol was first examined with a double-blind, randomized protocol in 35 subjects (methodological study group), and after that the administration of research drugs has been open-label. The study population consists of 7 subgroups, as described below. The study protocol of each subgroup has been approved by the ethics committee of the Pirkanmaa Hospital District (Ethics committee ID's above), and the administration of research drugs has also been approved by the Finnish Agency for Medicines (EudraCT-numbers above).