COMPARATIVE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN PREGNANT WOMEN WITH GESTATIONAL AND CHRONIC ARTERIAL HYPERTENSION

Abstract

Objective: The aim of this study was to analyze the efficacy of antihypertensive therapy in pregnant women with mild to moderate Gestational Hypertension (GH) and Chronic Arterial Hypertension (CAH) to achieve target blood pressure (BP). Design and method: The retrospective analysis of management of mild to moderate hypertension during pregnancy of 100 women with GH and 100 women with CAH was conducted. The regimes of drug therapy and their effectiveness were analyzed. The criterion of the efficacy of antihypertensive therapy was target office BP level less than 150–100 mm Hg in accordance with the National Guidelines. Office BP levels were registered twice a month during pregnancy. Results: The average age of women with CAH and GH was 34,0 ± 6,2 and 31,8 ± 5,1 years old relatively. To achieve target BP, regular antihypertensive therapy was required in 84% of pregnant women with CAH and 68% women with GH. In all cases methyldopa was administered, less often it was a combination with amlodipine. To control BP in 61% of pregnant women with GH was sufficiently lower doses of 250–750 mg daily methyldopa. But women with CAH needed large doses of 1000–2000 mg daily methyldopa (46% vs 29% of GH, p < 0,05) or its combination with amlodipine 5–10 mg daily (16% vs 8% of GH). Target BP levels were achieved in 90% of CAH and 96% of GH. There were no significant differences in maternal and fetal outcomes. Nevertheless, the incidence of preeclampsia with GH was slightly higher than with CAH (10% vs 6%, p > 0,05). In all cases of preeclampsia, low doses of methyldopa 250–500 mg or episodic use were needed to control BP during the previous period of pregnancy. Conclusions: Target BP levels were achieved by the monotherapy of methyldopa in most pregnant women with mild to moderate CAH and GH. Pregnant women with CAH needed large doses of methyldopa in comparison with GH. Despite effective therapy, the incidence of preeclampsia with GH was higher than with CAH. It is not quite clear the value of blood pressure control in the development of complications in pregnant women with mild to moderate hypertension.