Objective To evaluate the efficacy of hemodynamic profiling (HDpro)-guided antihypertensive therapy in elderly patients with uncontrolled morning hypertension.

Methods A multicenter randomized controlled trial was conducted in 9 hospitals in Zhejiang Province, enrolling 308 elderly patients (≥60 years old) with uncontrolled morning hypertension. Participants were randomly allocated to either the HDpro group or the control group. All patients underwent hemodynamic mapping and were categorized into one of five types as high cardiac index (CI) phenotype, high aortic stiffness (AS) phenotype, high systemic vascular resistance index (SVRI) phenotype, high thoracic blood volume ratio (TBR) phenotype and mixed type. Patients in the HDpro group received antihypertensive therapy tailored to their specific hemodynamic pattern, whereas those in the control group received standard empirical treatment based on clinical guideline. All participants were followed up for a period of 3 months. Office blood pressure (BP) measurements and 24-hour ambulatory blood pressure monitoring (ABPM) were performed before and after the intervention to evaluate antihypertensive effectiveness.

Results A total of 282 (142 in the HDpro group and 140 in the control group) were included in the study with complete follow-up. The hemogram classification in the HDpro group and control group was as follows: 17 and 19 cases of high CI type, 23 and 21 cases of high AS type, both 24 cases of high SVRI type, 19 and 17 cases of high TBR type, and both 59 cases of mixed type. At baseline, no statistically significant differences were observed between the two groups in terms of gender distribution, age, body mass index (BMI), prevalence of diabetes mellitus or dyslipidemia, HDpro parameters and phenotype, blood lipid and glucose levels, renal function, office BP, and ABPM levels. Following the intervention, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the HDpro group were significantly lower than those in the control group by (7.25±2.18) mmHg and (2.90±1.21) mmHg, respectively. The reductions in SBP and DBP during the early morning, daytime, nighttime, and 24 hours were significantly greater in the HDpro group than the control group (P＜0.05). The office BP control rate in the HDpro group was significantly higher than that in the control group (77.5% vs. 65.0 %, χ²=4.65, P＜0.05). Similarly, the control rates during morning (40.1% vs. 25.7%, χ²=6.26, P＜0.05) and daytime (38.7% vs. 25%, χ²=6.12,P＜0.05) were also significantly higher in the HDpro group than the control group . In subgroups including individuals aged 70 years and above, females, those with BMI ＜24 kg/m², and those with lower baseline office BP, higher morning, daytime, nighttime, and 24-hour SBP, as well as lower morning, daytime, nighttime DBP and higher 24-hour DBP, the HDpro group demonstrated significantly superior achievement of target levels than the control group (all P＜0.05).

Conclusions The individualized antihypertensive regimen, guided by hemodynamic mapping, can significantly reduce blood pressure levels in elderly patients with morning hypertension and improve the overall blood pressure control rate. Notably, in patients exhibiting higher SBP in ABPM, hemodynamic mapping-guided group achieved better blood pressure control compared to the control group.