Comparative analysis of the effect of two antihypertensive therapy regimens on maternal hemodynamic parameters in earlyand late-onset preeclampsia

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Abstract

Objective: To investigate the effect of antihypertensive therapy on maternal hemodynamic profile and the relationship between hemodynamic parameters and endothelial glycocalyx (eGCX) status in patients with preeclampsia. Materials and methods: The study comprised 82 patients, including women with uncomplicated pregnancy (n=30, comparison group) and patients with preeclampsia (n=52, study group) receiving monoor combined antihypertensive therapy. Monotherapy consisted ofDopegit (mean dose 1500mg/day) and two-component therapy included Dopegit (mean dosage 2000 mg/day) and Cordaflex (mean dosage 40 mg/day). All hypertensive patients underwent 24-hour ambulatory blood pressure monitoring (24h-ABPM) using a BPLab device (Peter Telegin, Nizhny Novgorod, Russia). Blood components of eGCX were measured by an enzyme immunoassay. Results: Early-onset preeclampsia was associated with worse perinatal outcomes, such as earlier gestational age at delivery, lower birth weight, and a lower Apgar score. Patients with early-onset preeclampsia receiving two-component therapy had higher systolic and diastolic BP. In patients with early-onset preeclampsia, (dP/dt)max values were significantly elevated, most markedly in patients on two-component antihypertensive therapy. This subgroup also had a higher augmentation index (AIx) and a higher RWTTindex. Patients with late-onset preeclampsia on monotherapy showed a significant increase in (dP/dt)max and ED; they also had a borderline signif icant increase in AIx. All patients receiving Dopegit monotherapy had a signif icant increase in syndecan-1 blood levels. Patients with early-onset preeclampsia on two-component therapy showed a significant decrease in hyaluronan levels and a borderline significant increase in syndecan-1 levels compared to women with healthy pregnancy. No signif icant differences in eGCX status were detected in patients with late-onset preeclampsia. Conclusion: The findings suggest a pathogenetic link between molecular and functional vascular changes, which is partially compensated by antihypertensive therapy. In early-onset preeclampsia, antihypertensive therapy is less effective because hemodynamic changes are not corrected by Dopegit and Cordaflex. At the same time, in late-onset preeclampsia the effectiveness of combined antihypertensive therapy is confirmed by compensation of hemodynamic parameters of the maternal cardiovascular system.

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About the authors

Kamilla T. Muminova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: kamika9l@mail.ru
PhD, Researcher at the High Risk Pregnancy Department

Zulfiya S. Khodzhaeva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: z_khodzhaeva@oparina4.ru
Dr. Med. Sci., Professor, Deputy Director of Obstetrics Institute

Kseniia A. Gorina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: kseniiagorina@gmail.com
PhD, Researcher at the High-Risk Pregnancy Department

Roman G. Shmakov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: mdshmakov@mail.ru
Dr. Med. Sci., Professor, Director of the Institute of Obstetrics

Marina M. Ziganshina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: mmz@mail.ru
PhD (Bio), Leading Researcher at the Laboratory of Clinical Immunology

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