Role of Pulse Pressure in Worsening the Renal Function of Patient with Hypertension

Abstract

Conclusion:Continuous epidural ropivacaine infusion as labor analgesia improves uteroplacental blood flow in hypertensive pregnant women with abnormal umbilical artery Doppler indices. Thus epidural analgesia is a better option in women with compromised fetuses.Background: Implementation of guidelines in hypertension remains challenging in primary care. Interventions are needed to improve hypertension management using guidelines.Objectives: To evaluate effectiveness of an intervention using guidelines in reducing blood pressure in patients with hypertension.Method: This before-and-after study was conducted in a primary care clinic for six months. The intervention involved professional training, availability of hypertension guideline and structured format of medical notes for hypertension. Primary outcome is the change in proportion of patients with uncontrolled BP (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) and secondary outcome is the mean BP change at 6 months. Results:A total of 555 patients were recruited. At baseline, 227/555 (40.9%) had uncontrolled BP. By 6 months 186/463 (40.2%) was uncontrolled. Among those with uncontrolled BP at baseline, 51.8% had BP controlled at 6 months; SBP in the uncontrolled group decreased from 147.8 (11.2) to 138.8 (15.2) mmHg (p < 0.001, CI: 6.6, 11.4); DBP decreased from 83.7 (8.0) to 79.6 (8.3) mmHg (p < 0.001, CI: 2.610, 5.493). Among those with controlled BP, 34.4% became uncontrolled at 6 months. For the controlled group, the SBP in the controlled group increased from 125.8 (7.4) to 133.6 (12.8) mmHg (p < 0.001, CI: −9.475, −6.155); DBP increased from 75.6 (6.1) to 77.5 (7.4) mmHg (p < 0.001, CI: −2.984, −0.897).Background: Hypertension in pregnancy remains a major cause of maternal and perinatal morbidity and mortality worldwide. The purpose of this study was to compare maternal and neonatal outcomes among women with hypertension (chronic hypertension (CHT), superimposed preeclamsia (SuperPE), gestational hypertension (GHT), mild preeclamsia (MPE), severe preeclamsia (SeverePE),and HELLP syndrome (HELLPs)).Methods: This retrospective evaluation was performed during January to December 2013 at Cipto Mangunkusumo Hospital, Jakarta-Indonesia, a tertiary-care hospital. The data was obtained from singleton deliveries database including women with hypertension(CHT, SuperPE, GHT, MPE, SeverePE,HELLPs) and control group (normotension and without comorbidities). Univariate and multivariate logistic regression analysis were performed.Results: There were 2103 deliveries in RSCM, 510 (24.3%) had hypertension in pregnancy and 1593 (75.7%) were control subject. CHT, SuperPE, GHT, MPE, severePE, HELLPs, were respectively found in 0.3%, 0.8%, 2.9%, 2.1%, 16.3%, and 1.8% in our patients. After adjusting with age, parity and comorbidities, the risk of having premature neonates are increased in women with HELLPs (adjustedOR 7.72; 95% Confidence interval (CI) 2.75-21.70), and superPE (aOR 4.41; 95% CI 1.23-15.89). Low birth weight (LBW) are increased in women with SeverePE (aOR 1.69; 95% CI 1.05...