Abstract
Background. Hypertensive disorders in pregnancy have been recognized as an important risk factor for atherosclerotic CVD in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. There are no uniform recommendations for the treatment of post partial hypertension (HT) yet.Methods. In a case-control, open-label 1-year study, 54 post-partum hypertensive women (aged 22-38 years; body mass index 26.7±3.8 kg/m2; 18 with previous pre-eclampsia, 18 pre-existing HT, 18 pre-existing HT plus superimposed pre-eclampsia) were studied. Nursing mothers (n=27) received adjusted-dose methyldopa (Egis) 500-2000 mg daily, 27 non-feeding women received indapamide SR (Servier) 1.5 mg daily. No significant differences observed between two groups at baseline.Results. After comprehensive follow-up, clinical blood pressure was not found to differ substantially between indapamide and methyldopa groups (124.8±3.2/83.2±2.1 mmHg vs 125.3±3.8/81.5±2.9 mmHg respectively; p =NS), but indapamide significantly better improved diurnal BP patterns. No maternal adverse effects were registered in both groups, except for sleepiness and bad mood in 18.5% of methyldopa patients. There was a significant difference in weight reduction, in favour of indapamide (-11.3 kg vs -2.7 kg; p =0.032), as well as in decrease of microalbuminuria (-189.2 mg/24 h vs -51.4 mg/24 h; p <0.001) and left ventricular mass index (-25.3 g/m2 vs -10.5 g/m2; p =0.021). No significant changes in lipid and glucose metabolism were found in both groups. Treatment with indapamide significantly improved endothelial function, non-invasively assessed by flow-mediated dilatation of the brachial artery using high-resolution ultrasound (+9.3% vs +2.9%; p =0.041). Moreover, indapamide demonstrated a good safety profile and led to high adherence to treatment. In the methyldopa group, no reduced milk production and offspring adverse effects were observed.Conclusions. The results provide support for indapamide SR as an effective and safe therapy of hypertension after delivery. Indapamide is superior to methyldopa in women with post partial hypertension.
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