Medical treatment of early‐onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications

Vasapollo, B.; Novelli, G. P.; Gagliardi, G.; Tiralongo, G.; Pisani, I.; Manfellotto, Dario; Giannini, Luigi; Valensise, H.

doi:10.1002/uog.11103

Cited by 26 publications

(38 citation statements)

References 30 publications

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“…As recently reviewed, few trials have evaluated hemodynamic‐guided antihypertensive therapy in pregnant women 7. Similar to the non‐pregnant literature, antihypertensive therapy based on cardiac output and total peripheral resistance may be an effective therapeutic strategy to improve maternal blood pressure control 23, 26, 27, 28, 29. Hemodynamic‐guided antihypertensive therapy for pregnant women presenting with any type of hypertension significantly reduced the rates of severe maternal hypertension from 18% to 3.5%, when compared with standard care 30.…”

Section: Discussionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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BackgroundHypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy.Methods and ResultsTwenty‐six normotensive pregnant women from a specialized Placenta Clinic at increased risk of developing de novo hypertension and 20 normotensive healthy pregnant controls were recruited at 22 to 26 weeks' gestation. Fourteen maternal clinical, hemodynamic, and placental characteristics were assessed in the second trimester and aggregated. Principal component analysis of this combined data set determined that 3 dimensions accounted for 56% of the cohort variability. The first dimension accounted for 31% of the cohort variability, with significant contributions from total peripheral resistance, endoglin, and cardiac output. The second dimension was predominantly influenced by body mass index and mean arterial pressure, while uric acid and myeloperoxidase mainly contributed to the third dimension. Unsupervised clustering identified 3 groups within this combined data set. Total peripheral resistance was the most significant distinguishing parameter between these groups (P<0.0001), followed by placental growth factor, endoglin, and cardiac output (P<0.0001). Using these 4 parameters, a receiver operating curve was constructed with an area under the curve of 0.975 (95% confidence interval 0.93–1) for the prediction of developing hypertension in pregnancy.ConclusionsConsolidated assessment of prognostic indicators in the second trimester of pregnancy may be useful to characterize and distinguish pathways by which women may develop hypertension in pregnancy. This approach could contribute to the development of pathway‐specific preventative and antihypertensive treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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“…No intervention has yet been successful in improving growth when growth restriction is detected, although maternal rest, treatment of hypertension, and maternal anemia may improve growth restriction [391]. Depending on gestational age, one strategy is to try to postpone delivery in order to improve fetal maturity, until it shows a good capacity for adaptation.…”

Section: Consensus Recommendationsmentioning

confidence: 99%

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Brenner

Charlton

Luyckx

et al. 2017

Nephron

119

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Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.

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“…An experimental approach in high peripheral resistance-low cardiac output patients has been tried with promising results both in mild gestational hypertension 21 and in hypertensive patients with foetal growth restriction 22 . This type of approach has led to a reduction of complications including PE 21,22 .…”

Section: Haemodynamic Differences Between Early and Late Pementioning

confidence: 99%

Pre-Eclampsia: One Name, Two Conditions – The Case for Early and Late Disease Being Different

Valensise

Novelli²,

Vasapollo

2013

Fet. Matern. Med. Rev.

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Medical treatment of early‐onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications

Abstract: Objective Complications in early-onset mild gestational hypertension (GH) are better predicted by total peripheral vascular resistance (TPVR)>

Cited by 26 publications

References 30 publications

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Pre-Eclampsia: One Name, Two Conditions – The Case for Early and Late Disease Being Different

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