Role of maternal hemodynamics in choosing antihypertensive therapy: concept shift

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Abstract

Antihypertensive drugs used in pregnancy can reduce blood pressure (BP) by different mechanisms; however, none of these drugs has an advantage over the other. Due to the comparable efficacy and safety profile as outlined in national and international guidelines, the choice of antihypertensive drug in pregnancy is ultimately dependent on the doctor’s expertise, consideration of potential side effects and contraindications, availability, and cost. The risk for hypertension in pregnancy is determined by a woman’s baseline hemodynamic profile. Thus, as a rule, there is a decrease in cardiac output and increased peripheral vascular resistance in patients with preeclampsia even before pregnancy. Numerous hemodynamic studies with promising results suggest a new, phenotype-based approach to the selection of antihypertensive therapy used in pregnancy. The choice of hypotensive therapy is based on hemodynamic changes in a woman rather than on BP readings. It is recommended to prescribe a beta-blocker if cardiac output is increased (usually it is accompanied by decreased vascular resistance), but if vascular resistance is increased (usually it is accompanied by decreased cardiac output), it is recommended to prescribe a vasodilator. It is possible to correct the prescribed therapy during dynamic monitoring of its effectiveness if hemodynamic parameters normalize. This innovative concept has been shown to lead to better pregnancy outcomes, namely, faster achievement of target BP, lower incidence of severe hypertension, decreased rates of iatrogenic preterm labor and low birth weight babies.

Conclusion: Further large-scale studies are necessary to determine the optimal BP in pregnancy, as currently, there is no general consensus regarding this issue. Additionally, there is a need to investigate the efficacy of hemodynamically-based therapy for hypertension in pregnancy. This will facilitate the development of individualized therapeutic approaches.

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About the authors

Kamilla T. Muminova

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

Author for correspondence.
Email: kamika91@mail.ru

Junior Researcher at High Risk Pregnancy Department

Russian Federation, Moscow

Marina M. Ziganshina

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

Email: m_ziganshina@oparina4.ru

Senior Researcher at the Department of Clinical Immunology

Russian Federation, Moscow

Zulfiya S. Khodzhaeva

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

Email: zkhodjaeva@mail.ru

Dr. Med. Sci., Professor, Head of High Risk Pregnancy Department

Russian Federation, Moscow

Igor I. Baranov

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

Email: i_baranov@oparina4.ru

Dr. Med. Sci., Professor, Head of Scientific and Educational Programs Department

Russian Federation, Moscow

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