Drug Treatment of Hypertension in Pregnancy

Brown, Catherine; Garovic, Vesna D.

doi:10.1007/s40265-014-0187-7

Cited by 104 publications

(89 citation statements)

References 69 publications

(72 reference statements)

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“…Recently it was shown that both APA and P-LAP could be potentially safe and effective drugs for preeclampsia and preterm labor [60,62,63]. This suggests that both APA and P-LAP not only prevent these fetal peptide hormones from entering maternal circulation, but also degrade peptide hormones in maternal circulation and thus treat both preeclampsia and preterm labor.…”

Section: Discussion and Conclusion ▼mentioning

confidence: 99%

New Insights into the Role of Sex Steroid Hormones in Pregnancy: Possible Therapeutic Approach by Sex Steroid Hormones for the Treatment of Both Preeclampsia and Preterm Labor

Mizutani

2015

Exp Clin Endocrinol Diabetes

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Fetal peptide hormones are essential for the development of fetus, which increase in accordance with pregnancy term. Concentration of these hormones within the feto-placental unit is normally higher than that of maternal circulation. Since these hormones are biologically active, the leakage of these hormones into the maternal circulation is regulated by degradation activity by placental aminopeptidases, in order to maintain the balance between carriage of pregnancy and onset of labor.Because the concentration of these hormones, being regulated by the amount of endogenous production and by physiological degradation by enzymes in the blood and tissue, the balance between production and degradation is a definitive element for maintaining normal gestation and term delivery.The changes of the balance between fetal angiotensin II (A-II) and vasopressin (AVP) andA-II and AVP degrading enzymes, between aminopeptidase A (APA) and placental leucine aminopeptidase( P-LAP) - in the placenta and maternal blood due to fetal stress such as hypoxia - are the provable causes of preeclampsia or preterm labor.Induction of APA and P-LAP by estradiol benzoate (E2) and progesterone (P) from placenta has been demonstrated. They are involved in the regulation of fetal peptide hormones via placental aminopeptidases in homeostasis of pregnancy.Recently it was shown that both APA and P-LAP could be potentially safe and effective drugs for preeclampsia and preterm labor. The authors' proposed sex steroid treatment with dose increasing manner by gestational week (sex steroid treatment) for severe preeclampsia and preterm labor could be candidates replacing conventional treatments. In light of lacking safe and effective medication, the proposed sex steroid treatment is worthwhile for the prospective controlled studies for the treatment of both preeclampsia and preterm labor.

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Section: Discussion and Conclusion ▼mentioning

confidence: 99%

New Insights into the Role of Sex Steroid Hormones in Pregnancy: Possible Therapeutic Approach by Sex Steroid Hormones for the Treatment of Both Preeclampsia and Preterm Labor

Mizutani

2015

Exp Clin Endocrinol Diabetes

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“…[43][44][45] Drug preference will depend on setting, the physician, and fetal-maternal adverse effects (see ►Table 1). 41,44,[46][47][48][49] Labetalol and nifedipine have shown similar efficacy and safety in this context. 50 Both short-acting (capsules) and intermediate-released (tablets) nifedipine were effective for controlling severe hypertension compared with IV hydralazine, IV labetalol, and other drugs.…”

Section: Treatment Of Severe Hypertensionmentioning

confidence: 91%

“…41,53 Sodium nitroprusside, for shortterm use, may be required for uncontrollable hypertension. 47 Antihypertensive drugs contraindicated during pregnancy are atenolol, for its association with fetal growth restriction, and angiotensin-converting enzyme (ACE) inhibitors, for their association to oligohydramnios, fetal renal failure, and stillbirth. 47 Treatment for postpartum patients with severe hypertension can be initiated with any of the previously mentioned drugs with the exception of nitroprusside due to the potential of thiocyanate toxicity for breastfeeding infants.…”

Section: Treatment Of Severe Hypertensionmentioning

confidence: 99%

Obstetric Disorders in the ICU

Vásquez

Plante

Basualdo³

et al. 2017

Semin Respir Crit Care Med

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Pregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment. We will also cover some specific, although less frequent, obstetric disorders, such as acute fatty liver of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. Our primary aim is to improve quality of care for these types of patients.

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“…; Al‐Balas et al . ), has stimulated the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy to formulate the statement that the concern for the use of diuretics in pregnancy should be considered primarily theoretical (NHBPEPWGHBPP, ; Brown & Garovic, ). These arguments, together with the recognition that late‐onset preeclampsia is predominantly related to a volume overloaded state, has initiated research into the value of diuretics in the management of late‐onset preeclampsia, with preliminary promising effects (Tamás et al .…”

Section: Common Clinical Characteristics Of Cardiorenal Syndromes Andmentioning

confidence: 99%

“…Despite the use of diuretics as antihypertensive agents outside pregnancy (Veena et al 2017), abstinence from application during pregnancy has long been advocated because of the observed increase of peripheral resistance in a group of pregnant women with chronic hypertension (Carr et al 2007). The lack of terotogenic or clinical neonatal side effects in pregnancies with maintenance of chronic diuretic treatment or with acute cardiac or nephrological problems (von Dadelszen et al 2007;Al-Balas et al 2009), has stimulated the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy to formulate the statement that the concern for the use of diuretics in pregnancy should be considered primarily theoretical (NHBPEPWGHBPP, 2000;Brown & Garovic, 2014). These arguments, together with the recognition that late-onset preeclampsia is predominantly related to a volume overloaded state, has initiated research into the value of diuretics in the management of late-onset preeclampsia, with preliminary promising effects (Tamás et al 2017).…”

Section: Pharmacotherapeutic Targetsmentioning

confidence: 99%

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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Drug Treatment of Hypertension in Pregnancy

Cited by 104 publications

References 69 publications

New Insights into the Role of Sex Steroid Hormones in Pregnancy: Possible Therapeutic Approach by Sex Steroid Hormones for the Treatment of Both Preeclampsia and Preterm Labor

New Insights into the Role of Sex Steroid Hormones in Pregnancy: Possible Therapeutic Approach by Sex Steroid Hormones for the Treatment of Both Preeclampsia and Preterm Labor

Obstetric Disorders in the ICU

Preeclampsia: a gestational cardiorenal syndrome

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