Mothers with post-partum hypertension and kidney damage after pre-eclampsia should receive ACE inhibitors rather than methyldopa

Abstract

Background Both hypertension (HT) and pre-eclampsia (PE) have been recognized as an important cause of chronic kidney disease (CKD) in women. There are no uniform recommendations for the treatment of HT with kidney damage after PE yet. Methods In a case-control, open-label 1-year study, 54 post-partum women (aged 25–37 years) with grade 2 (53.7%) or 3 (46.3%) HT and kidney damage [48 patients (88.9%) had moderately increased albuminuria (30–299 mg/g), 6 (11.1%) – severely increased albuminuria (>300 mg/g), 32 (59.3%) – mildly decreased eGFR (60–89 mL/min/1.73 m2 (BSA)) and 3 (5,6%) – mildly to moderately decreased eGFR (45–59 mL/min/1.73 m2)] after early-onset PE (with delivery at <34+0 weeks of gestation) superimposed to HT received either adjusted-dose ACE inhibitors – ACEi (33 non-feeding mothers: 19 – perindopril, 5 – ramipril, 9 – perindopril and indapamide SR combination) or methyldopa (21 nursing women). No significant differences observed between two groups at baseline. Results After comprehensive follow-up, blood pressure (BP) was not found to differ between ACEi and methyldopa groups (123.2±2.4/78.5±1.5 mmHg vs. 136.2±4.8/86.2±3.2 mmHg respectively, p>0.05) with more strict BP control on ACEi. There were significant differences in albuminuria reduction, in favour of ACEi (–207.2 mg/24 h vs. –33.7 mg/24 h, p<0.01) and in eGFR increasing (+19.4 mL/min/1.73 m2 (BSA) vs. +6.6 mL/min/1.73 m2 (BSA), p=0.029), as well as in decrease of left ventricular (LV) mass index (−31.2 g/m2 vs. −16.7 g/m2, p=0.038) and increase of LV ejection fraction (+8.2% vs. +1.9%, p=0.022). Treatment with ACEi more improved endothelial function, non-invasively assessed by flow-mediated dilatation of a brachial artery using high-resolution ultrasound (+10% vs. +3.4%, p=0.035) and decreased intima media thickness (−0.33 mm vs. −0.17 mm, p=0.009). In a year, all methyldopa patients had albuminuria, C1 stage of CKD was in 13 (61.9%) women, CKD C2 in 8 (38.1%). In ACEi group, CKD C1 had 7 (21.2%) mothers (p<0.01), C2 – none (p<0.01). Conclusion Non-feeding women with grade 2 or 3 post-partum HT and renal damage after early-onset PE get greater heart, kidney and vessels benefits from 1-year ACEi treatment than nursing mothers from methyldopa. Funding Acknowledgement Type of funding source: None