Treatment Of Hypertension In Pregnancy Research Articles

The treatment of hypertension in pregnancy

Hypertension in pregnancy is a leading cause of maternal death. It may represent pre-existing or secondary hypertension, or may have been induced by the pregnancy. Pregnancy induced hypertension may develop after 20 weeks' gestation, is not associated with proteinuria, and generally resolves 6 weeks post partum. In mothers who are genetically predisposed, pregnancy induced hypertension may take the form of pre-eclampsia, a condition characterized by hypertension, oedema and proteinuria. Antihypertensive drugs administered during the first trimester may have teratogenic effects (weeks 3–11 of pregnancy are the period of greatest risk). Drugs given later in pregnancy may adversely affect fetal growth and development. Those given close to term may impair labour or have adverse effects on the neonate. An appendix to the British National Formulary lists the risks associated with the use of antihypertensive drugs during the trimesters of pregnancy. Antihypertensive drugs commonly used in pregnant women include methyldopa (a drug that gives rise to a false sympathomimetic neurotransmitter), hydralazine (a vasodilator that may interfere with the intracellular release of calcium), labetalol (an antagonist at alpha one and beta one adrenoceptors with partial agonist activity at beta two adrenoceptors), nifedipine (an inhibitor of calcium influx through L-type channels in vascular smooth muscle), and doxazosin and prazosin (antagonists at alpha one adrenoceptors). Magnesium sulphate is useful for the prevention and treatment of seizures associated with eclampsia, but its co-administration with nifedipine is best avoided.

Use of Noninvasive Positive Airway Pressure During Wakefulness for the Treatment of Hypertension in Pregnancy

Use of Noninvasive Positive Airway Pressure During Wakefulness for the Treatment of Hypertension in Pregnancy

The treatment of severe hypertension in pregnancy: a review of current practice and knowledge in West-Midlands maternity units

The treatment of severe hypertension in pregnancy: a review of current practice and knowledge in West-Midlands maternity units

Pharmacological treatment of hypertension in pregnancy.

The hypertensive disorders of pregnancy complicate 5-10% of pregnancies. Of these disorders 70% are pregnancy related (preeclampsia-eclampsia and gestation hypertension) and 30 % are a pre-existing hypertensive condition (chronic hypertension). These disorders are associated with maternal and fetal complications and have a substantial economic impact. This review examined the pharmacological treatment of the hypertensive disorders of pregnancy. There is a general consensus that anti-hypertensive should be given with severe hypertension and this should be in the hospital. The value of antihypertensive drugs in pregnant women with mild hypertension continues to be an area of debate that the evidence is too scanty to securely evaluate the clinical benefits of treating mild hypertension during pregnancy. The choice of the antihypertensive agents depends on individual clinician preference, the specified maternal and foetal benefits and the reproductive complications (teratogenisity, fetotoxicity and neonatal toxicity) of each particular agent. There are unequivocal evidences that Magnesium sulphate is superior to other agents in reducing recurrent eclamptic seizures. There is a strong recent evidence recommended that magnesium sulphate should be considered for women with pre-eclampsia for whom there is concern about the risk of eclampsia.

Enantioselectivity in the steady-state pharmacokinetics and transplacental distribution of pindolol at delivery in pregnancy-induced hypertension.

Nine patients taking oral doses of 10 mg/12 h rac-pindolol as part of their treatment for hypertension in pregnancy were recruited for the study. Maternal and fetal gestational age ranged from 20-38 years and 28-41 weeks, respectively. Blood was collected from the umbilical cord vein and from the mother from zero to 12 h after drug administration. Urine was collected for 12 h after rac-pindolol administration at the following intervals: 0-3, 3-6, 6-9, and 9-12 h. Plasma and urine concentrations of the pindolol enantiomers were determined by HPLC using a Chiralpak AD chiral column and fluorescence detection. The data were fitted to a one-compartment model and differences between (+)-R and (-)-S enantiomers were compared by the paired t-test (P < 0.05). Mean results are reported. The disposition of pindolol in maternal plasma was stereoselective, with higher AUC(SS)0-12 (84.34 vs. 95.69 ng.h/ml) and Cl(R) values (9.16 vs. 10.85 L/h) and lower Vd/f (251.38 vs. 225.17 L) and Cl/f (62.48 vs. 55.74 L/h) for the (+)-R pindolol. The transplacental distribution of pindolol was not stereoselective. Cord, plasma, and presumably fetal, concentrations of the pindolol enantiomers were 56% of the maternal plasma concentrations up to 6 h after the last dose.

Treatment of Hypertension in Pregnancy

Treatment of Hypertension in Pregnancy

Treatment of hypertension in pregnancy: effect of atenolol on maternal disease, preterm delivery, and fetal growth

OBJECTIVE: To assess the impact of antihypertensive therapy initiated early in pregnancy on maternal and fetal outcomes. METHODS: A retrospective review of patients treated in early pregnancy with atenolol was conducted. Therapy was directed by measurements of cardiac output. Fetal growth was analyzed with reference to prior pregnancy outcome, treatment inconsistent with standards present at the end of the study period, and year of treatment. Data were analyzed by paired and unpaired t-test, analysis of variance for multiple comparisons, and linear regression. RESULTS: Two hundred thirty-five pregnancies at risk for preeclampsia were studied. Ten percent ( n = 22) received additional therapy with furosemide; 20% ( n = 48) with hydralazine. Six and one half percent had treatment inconsistencies. Fifty-five percent had greater than 100 mg of proteinuria at baseline. One patient developed severe preeclampsia. Only 2.1% delivered before 32 weeks; 4.7% delivered before 34 weeks. Low percentile birth weight was strongly associated with a prior pregnancy with intrauterine growth restriction ( P = 0.001), treatment inconsistency ( P < .001), and a pregnancy earlier in our treatment experience ( P < .001). Percentile birth weight increased from the 20th at the beginning of the study period to the 40th by the end ( P = 0.002). CONCLUSION: Early intervention with antihypertensive therapy was associated with a low rate of severe maternal hypertension and preterm delivery. The failure to adjust therapy in response to an excessive fall in cardiac output or increase in vascular resistance was associated with reduced fetal growth.

Working Group Report on High Blood Pressure in Pregnancy

This report updates the 1990 National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy and focuses on classification, pathophysiology, and management of the hypertensive disorders of pregnancy. Using evidence‐based medicine and consensus, this report updates contemporary approaches to hypertension control during pregnancy by expanding on recommendations made in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The recommendations to use K5 for determining diastolic pressure and to eliminate edema as a criterion for diagnosing pre‐eclampsia are discussed. In addition, the use of blood pressure increases of 30 mm Hg systolic or 15 mm Hg diastolic as a diagnostic criterion has not been recommended, as available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Management considerations are made between chronic hypertension that is present before pregnancy and those occurring as part of the pregnancy‐specific condition preeclampsia, as well as management considerations in women with comorbid conditions. A discussion of the pharmacologic treatment of hypertension in pregnancy includes recommendations for specific agents. The use of low‐dose aspirin, calcium, or other dietary supplements in the prevention of pre‐eclampsia is described, and expanded sections on counseling women for future pregnancies and recommendations for future research are included. Once again we thank Dr. Ray Gifford, Jr., and his committee for volunteering their time to produce this important report. We hope it helps the busy clinician prevent and manage a very important problem.—Claude Lenfant, MD, Director, National Heart, Lung, and Blood Institute, and Chair, National High Blood Pressure Education Program Coordinating Committee

Hypertensive disorders in pregnancy

Hypertensive complications contribute to maternal and fetal morbidity. Hypertensive diseases in pregnancy comprise various disorder from transient hypertension to the dangerous preeclampsia/eclampsia. Diagnosis of these diseases requires an understanding of the normal physiological adaptations during pregnancy. The primary cause of preeclampsia/eclampsia is a disturbed growth of throphoblast cells, probably induced by an altered maternal immunotolerance. The consequence is a dysfunction of endothelial cells with a decrease in perfusion of the uterus and placenta. The normal balance between vasoconstrictors and vasodilators is changed in favor of vasoconstrictors. Complex changes in the renin-angiotensin system have been detected resulting in an increased angiotensin II-mediated vasoconstriction. The reduction in perfusion of the uterus and placenta eventually leads to preeclampsia/eclampsia and growth retardation of the fetus. Manifest preeclampsia/eclampsia is characterized by disturbed microcirculation of target organs such as brain, liver and kidney. An involvement of the liver causes the HELLP syndrome. Various pharmacological approaches to prevent preeclampsia/eclampsia showed disappointing results, but patients with a risk for the eventual development of preeclampsia/eclampsia should be identified, closely monitored, and hypertension should be treated. A systolic blood pressure > 170 mm Hg and diastolic blood pressure > 100 mm Hg should be treated. Drugs such as alpha-methyldopa and dihydralazine that are well-characterized in their fetal effects are the primary choice for the treatment of hypertension in pregnancy. ACE-inhibitors and angiotensin II receptor antagonists are absolutely, diuretics are relatively contraindicated. The causal therapy for preeclampsia/eclampsia is delivery. Gravida before the 33th week of pregnancy should be admitted, hypertension should be treated, and the fetus should be monitored by duplex ultrasound and cardiotocography. New data suggest that early treatment with glucocorticoids may prevent the manifestation of HELLP syndrome. Hypertensive pregnant patients should be treated in tertiary centers with an interdisciplinary approach involving obstetricians, neonatologists, and nephrologists.

Fetal growth restricted by treatment of hypertension in pregnancy?

Fetal growth restricted by treatment of hypertension in pregnancy?

Fetal growth restricted by treatment of hypertension in pregnancy?

Fetal growth restricted by treatment of hypertension in pregnancy?

Nifedipine capsules for hypertension in pregnancy: easy and effective, but not exclusive: Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?

Nifedipine capsules for hypertension in pregnancy: easy and effective, but not exclusive: Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?

Nifedipine capsules for hypertension in pregnancy: easy and effective, but not exclusive: Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?

Nifedipine capsules for hypertension in pregnancy: easy and effective, but not exclusive: Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?

Nifedipine capsules for hypertension in pregnancy: easy and effective, but not exclusive: Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?

Nifedipine capsules for hypertension in pregnancy: easy and effective, but not exclusive: Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?

24‐hour blood pressure monitoring to evaluate the effects of nifedipine in pre‐eclampsia and in chronic hypertension in pregnancy

To investigate the effect of 7 to 14 days of therapy with nifedipine (sustained-release preparation) on the 24-hour blood pressure patterns of pregnant women with pre-eclampsia or chronic hypertension, and to test the utility of blood pressure monitoring in modulating the timing and dosage of the drug. 24-hour automatic blood pressure monitoring of pregnant women with pre-eclampsia or chronic hypertension before and after nifedipine treatment. Centre for Prevention, Diagnosis and Treatment of Hypertension in Pregnancy, University of Turin, Italy. Sixteen pregnant women with pre-eclampsia and 17 with chronic hypertension. 24-hour blood pressure monitoring was performed before the beginning of the therapy and after 7 to 14 days of treatment with sustained-release nifedipine. Chronobiological analysis of systolic and diastolic blood pressure values was performed; MESOR, amplitude, acrophase, hyperbaric index, percent time elevation and significance of rhythm were calculated before and after treatment. 6336 blood pressure measurements were analysed. Systolic and diastolic MESOR values were significantly decreased after nifedipine treatment both in pre-eclampsia and in chronic hypertension. However, the antihypertensive effect of nifedipine in pre-eclampsia was especially pronounced during evening and night, while in chronic hypertension it was more constant during the 24-hour period. 24-hour blood pressure monitoring allowed adjustment, when necessary, to the timing and dosage of nifedipine in accordance with the blood pressure patterns of each patient, using the hyperbaric index and percent time elevation as objective parameters for the evaluation of treatment efficacy. 24-hour blood pressure monitoring is a good method to optimise treatment, and confirms that nifedipine is useful for the control of maternal blood pressure in pregnancy.

Calcium channel blockade (isradipine) in treatment of hypertension in pregnancy: A randomized placebo-controlled study

OBJECTIVE: Our purpose was to study the effects of isradipine, a dihydropyridine calcium channel blocker, on mother and fetus in the treatment of hypertensive disorders of pregnancy. STUDY DESIGN: The investigation was performed as a two-group, parallel, double-blind multicenter study of isradipine versus placebo. Fifty-four women were randomized to treatment with isradipine slow-release capsules given orally 5 mg twice a day and 57 to a placebo group. RESULTS: Isradipine lowered the maternal mean arterial blood pressure effectively in women with nonproteinuric hypertension but did not do so in women with proteinuria at recruitment or appearing during treatment. Blood flow in the umbilical artery and maternal renal and liver function were not influenced by treatment. Isradipine had few side effets and was well tolerated. CONCLUSION: Calcium channel blockade with isradipine is effective for treatment of nonproteinuric hypertension but not in preeclampsia.

How Swedish obstetricians manage hypertensive disorders in pregnancy

To study treatment of hypertension in pregnancy in Sweden and compare our results with a similar study published in 1981. A multiple choice questionnaire was sent to 92 obstetricians throughout Sweden and 88% responded. Most Swedish obstetricians would treat a woman in the second trimester with blood pressure 140/95 mmHg without antihypertensive medication (83%) in the out-patient clinic (81%). The corresponding figures according to a similar study published in 1981 were 33% and 71% of obstetricians, respectively. Almost all obstetricians (95%) would give antihypertensive treatment if the blood pressure was 170/110 mmHg or more. Betablockers and hydralazine were the most commonly used drugs. Sixteen per cent of obstetricians would use calcium antagonists, drugs not available in the previous study. Treatment with diuretics, methyldopa or diazepam in hypertension was rarely used. Eight per cent of obstetricians would give low-dose aspirin to patients with mild hypertension and 20% to patients with severe hypertension. Fourteen per cent of obstetricians would stop all kind of antihypertensive medication and frequently observe patients with essential hypertension. Antihypertensive therapy and management of hypertensive disorders of pregnancy show a great disparity among Swedish obstetricians. National strategies might improve the morbidity and mortality associated with hypertensive disorders in pregnancy.

Pathophysiology of and therapeutic strategies for hypertension in pregnancy.

Approximately 8% to 10% of pregnancies are complicated by hypertension. The disease, whether it first appears during gestation or was present prior to conception, puts both mother and baby at risk. The fetal risks include death in utero, poor growth, and prematurity. The risks to the mother are more difficult to assess, but intracranial bleeding is the most common cause of death. This review examines some of the physiological changes that occur in normal pregnancy and defines the hypertensive disorders of pregnancy. The recent data regarding pharmacologic and nonpharmacologic therapies for the treatment of hypertension in pregnancy are discussed, and comments as to the prophylaxis of preeclampsia are noted.

Hypertension in pregnancy.

Hypertension in pregnancy is still one of the most important causes of maternal morbidity and mortality. Several different definitions are used, partly because the pathogenetic background to the hypertensive diseases of pregnancy is not known. Widely variable incidences have been reported in different populations, but a reasonable estimation is that less than 5% of pregnancies are complicated by clinically relevant blood pressure elevation. The treatment of hypertension in pregnancy has been a matter of debate, but in late pregnancy, there is agreement that delivery is the treatment of choice. In later years, antihypertensive drugs have been less used in mild or moderate hypertension in pregnancy. Low-dose aspirin may be useful as a preventive treatment in high-risk pregnancies, but final proof of this is still lacking. Long term follow-up of women with a hypertensive pregnancy is important, since a significant proportion of these women will develop later chronic (essential) hypertension, even if their blood pressure is completely normalised shortly after delivery.

Antihypertensive Therapy in the Management of Hypertension in Pregnancy - A Clinical Double-Blind Study of Pindolol

In order to investigate whether the early treatment of hypertension in pregnancy would have a beneficial effect on the outcome of the pregnancy, 60 women, presenting with a diastolic blood pressure of 85-99mmHg before the 35th week of pregnancy were randomly assigned either to treatment with pindolol or with a placebo. If DBP was consistently 100mmHg, the code was broken and patients receiving pindolol were given other antihypertensive agents and those in the placebo group were given pindolol initially followed by other agents in non-responders. The early treatment of hypertension was not associated with adverse effects in either mother or newborn. On the other hand, there were no beneficial effects either. Only 6 patients receiving pindolol required additional treatment whereas 15 patients receiving placebo required additional treatment (p=0.015). It is thus estimated that 50% of pregnant females with mild-moderate hypertension will eventually require antihypertensive therapy, while the remainder will be able to complete the pregnancy without treatment. Delaying the treatment of hypertension of pregnancy to DBP of 100mmHg is not associated with additional maternal or fetal risk and will reduce the number of patients receiving treatment to about half.