Paradigm shift in pharmacotherapy for late-onset preeclampsia: advantages of two-component antihypertensive therapy compared to monotherapy based on analysis of vasoactive status data in pregnant women
- Authors: Ziganshina M.M.1, Muminova K.T.1, Khodzhaeva Z.S.1, Оshkhunova M.S.1, Baranov I.I.1
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Affiliations:
- Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
- Issue: No 12 (2023)
- Pages: 104-113
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/625904
- DOI: https://doi.org/10.18565/aig.2023.240
- ID: 625904
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Abstract
An important aspect of the effectiveness of antihypertensive therapy is its effect on the production of vasoactive factors that control blood pressure (BP). The most commonly used drugs, methyldopa (Dopegyt) and nifedipine (Cordaflex), have different mechanisms for reducing BP; however, their impact on the production of vasoactive factors in pregnant women with preeclampsia (PE) has not been studied.
Objective: To characterize the vasoactive status of pregnant women with late-onset PE who received different antihypertensive therapy regimens: monotherapy with Dopegyt and two-component therapy with Dopegyt and Cordaflex.
Materials and methods: The study included 47 pregnant women with a gestational age > 34 weeks. The control group comprised 18 patients with healthy pregnancies, while the study group included 29 pregnant women with PE; 15 received antihypertensive monotherapy (Dopegyt) (Group 1), and 14 received two-component therapy (Dopegyt+Cordaflex) (Group 2). Clinical assessments included the following: 1) hemodynamic status based on 24-hour ambulatory blood pressure monitoring, considering parameters characterizing changes in central aortic pressure, intracardiac hemodynamics, and arterial stiffness; 2) hemodynamic status in the fetoplacental system based on Doppler findings; and 3) factors regulating vascular tone, thrombosis, and markers of cardiovascular insufficiency in peripheral blood based on the results of the immunoassay analysis.
Results: A balance was established between vasoconstrictors and vasodilators in pregnant women with late-onset PE who received both antihypertensive regimens. Pregnant women receiving two-component therapy exhibited a more compensated hemodynamic status. An increase in antithrombin levels in the blood of pregnant women who received both regimens was noted, presumably owing to the effects of Dopegyt.
Conclusion: In late-onset PE, antihypertensive therapy provides control of the humoral regulation of vascular tone and promotes a balance between vasoconstrictors and vasodilators. The use of two antihypertensive drugs with different mechanisms of action favorably influences the cardiovascular system of pregnant women and adequately regulates the synthetic function of endothelial cells.
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About the authors
Marina M. Ziganshina
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Author for correspondence.
Email: mmz@mail.ru
ORCID iD: 0000-0003-1578-8403
PhD (Bio), Leading Researcher at the Laboratory of Clinical Immunology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Russian Federation, MoscowKamilla T. Muminova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: kamika91@mail.ru
ORCID iD: 0000-0003-2708-4366
PhD, Researcher at the High-Risk Pregnancy Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Russian Federation, MoscowZulfiya S. Khodzhaeva
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: zkhodjaeva@mail.ru
ORCID iD: 0000-0001-8159-3714
Dr. Med. Sci., Professor, Deputy Director of Obstetrics Institute, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Russian Federation, MoscowMadina S. Оshkhunova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: madina.oshkhunova@mail.ru
ORCID iD: 0000-0002-7044-7962
PhD Student at the High-risk Pregnancy Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Russian Federation, MoscowIgor I. Baranov
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: i_baranov@oparina4.ru
ORCID iD: 0000-0002-9813-2823
Dr. Med. Sci., Professor, Head of the Department of Scientific and Educational Programs, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Russian Federation, MoscowReferences
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