Therapeutic approaches to the management of women with gestational hypertension: a cardiologist’s perspective.
Abstract
The need to expand knowledge about the early stages of gestational therapy for pregnant women with hypertensive disorders is driven by several factors. First, the selection of the optimal antihypertensive therapy regimen is limited by the feasibility of conducting large-scale studies in representative populations due to time constraints and the responsibility for the life of not only the mother but also the child. Second, current recommendations generally recommend initiating therapy by titrating a single drug regardless of blood pressure levels, limiting the use of combination regimens. Third, the identification of specific cardiac risks is limited by the timely implementation of an effective screening strategy.
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List of references
De Backer J., Haugaa K., et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. European Heart Journal. 2025;00:1-107. https://doi.org/10.1093/eurheartj/ehaf193.
Magee LA et al., NEJM, 2015;372:407–417. https://doi.org/https://doi.org/10.1056/NEJMoa1404595.
Tita ATN et al., NEJM, 2022;386:1781–1792. https://doi.org/10.1056/NEJMoa2201295.
Abalos E., Duley L., Steyn D.W., Henderson-Smart D.J. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews. 2018, Issue 10. Art. No.: CD002252. https://doi.org/10.1002/14651858.CD002252.pub4.
Sridharan K., Sequeira R.P. Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol. 2018;84(9):1906-1916. https://doi.org/10.1111/bcp.13649.PMID:29974489.
George R., Thomas C., Anna Joy C., Varghese B., Undela K., Adela R. Comparative efficacy and safety of oral nifedipine with other antihypertensive medications in the management of hypertensive disorders of pregnancy: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2022;40(10):1876–1886. https://doi.org/10.1097/HJH.0000000000003233.
Yin J., Mei Z., Shi S., Du P., Qin S. Nifedipine or amlodipine? The choice for hypertension during pregnancy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2022; 306(6): 1891–1900. https://doi.org/10.1007/s00404-022-06504-5.
Bajpai D., Popa C., Verma P., Dumanski S., Shah S. Evaluation and Management of Hypertensive Disorders of Pregnancy. Kidney360. 2023;4(10):1512-1525. https://doi.org/10.34067/KID.0000000000000228.
Awaludin A., Rahayu C., Daud N.A.A., Zakiyah N. Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022;10(2):325. https://doi.org/10.3390/healthcare10020325.
Rismiati H., Lee H.-Y. Blood pressure control in hypertensive disorders of pregnancy. Cardiovascular Prevention Pharmacotherapy. 2022;4(3):99-105. https://doi.org/10.36011/cpp.2022.4.e16.
Al Khalaf S., Khashan A.S., Chappell L.C., O’Reilly E´ .J., McCarthy F.P. Role of Antihypertensive Treatment and Blood Pressure Control in the Occurrence of Adverse Pregnancy Outcomes: A Population- Based Study of Linked Electronic Health Records. Hypertension. 2022;79(7):1548-1558. https://doi.org/ 10.1161/HYPERTENSIONAHA.122.18920.
Garcia JE, Mulrenin IR, Nguyen AB, Loop MS, Daubert MA, Urrutia RP, Lee CR. Antihypertensive medication use during pregnancy in a real-world cohort of patients diagnosed with a hypertensive disorder of pregnancy. Frontiers in Cardiovascular Medicine. 2023; 10:1225251. https://doi.org/10.3389/fcvm.20 23.1225251. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10360165/.
Brown CM, Garovic VD. Drug treatment of hypertension in pregnancy. Drugs. 2014 Mar;74(3):283-96. https://doi.org/10.1007/s40265-014-0187-7. PMID:24554373.
J Vaclavik, Z Ramik, J Jarkovsky, A Zouharova, R Pohlova, J Jirova European Heart Journal, Volume 45, Issue Supplement_1, October 2024, ehae666.2557, https://doi.org/10.1093/eurheartj/ehae666.2557 Published: 28 October 2024.
Duhalde V., Delarue C., Lacroix I., Suarez C., Bourrel R., Montastruc J.L., et al. (2011). Antihypertensive drug prescription pattern before and during pregnancy in France. Pregnancy Hypertens. Int. J. Women’s Cardiovasc. Health 1 (2), 185–189. https://doi.org/10.1016/j.preghy.2011.01.001.
di Pasquo E., Giannubilo S.R., Valentini B., Salvi S., Rullo R., Fruci S., et al. (2024). The “Preeclampsia and Hypertension Target Treatment” study: a multicenter prospective study to evaluate the effectiveness of the antihypertensive therapy based on maternal hemodynamic findings. Am. J. Obstet. Gynecol. MFM 6 (5), 101368. https://doi.org/10.1016/j.ajogmf.2024.101368.
Bortolotto M.R., Francisco R.P.V., and Zugaib M. (2018). Resistant hypertension in pregnancy: how to manage? Curr. Hypertens. Rep. 20 (8), 63. https://doi.org/10.1007/s11906-018-0865-z.
Ashworth D., Battersby C., Bick D., Green M., Hardy P., Leighton L., et al. (2023). A treatment strategy with nifedipine versus labetalol for women with pregnancy hypertension: study protocol for a randomised controlled trial (Giant PANDA). Trials 24 (1), 584. https://doi.org/10.1186/s13063-023-07582-9.
Fitton C.A., Steiner M.F.C., Aucott L., Pell J.P., Mackay D.F., Fleming M., et al. (2017). In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J. Hypertens. 35 (11), 2123–2137. https://doi.org/10.1097/HJH.0000000000001456.
Gestational Hypertension and Preeclampsia (2020). Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstetrics Gynecol. 135 (6), e237–e260. https://doi.org/10.1097/AOG.00 00000000003891.
Khan K.S., Wojdyla D., Say L., Gu¨lmezoglu A.M., and Van Look P.F. (2006). WHO analysis of causes of maternal death: a systematic review. Lancet 367 (9516), 1066–1074. https://doi.org/10.1016/S0140-6736(06)68397-9.
Hitti J., Sienas L., Walker S., Benedetti T.J., and Easterling T. (2018). Contribution of hypertension to severe maternal morbidity. Am. J. Obstet. Gynecol. 219 (4), e1–e405. https://doi.org/10.1016/j.ajog.2018.07.002.
Scott, G., Gillon T.E., Pels A., von Dadelszen P., and Magee L.A. (2022). Guidelines—similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension. Am. J. Obstet. Gynecol. 226 (2), S1222–S1236. https://doi.org/10.1016/j.ajog.2020.08.018.
Copyright (c) 2025 М.А. Садуллоева , Ф.А. Закирова , С.А. Икрамова , Р.Р. Хазраткулов , М.М. Рустамов (Автор)
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