Cardiology Letters 2015, 24(6):425-429

Treatment of hypertension in pregnancy: a 3-year retrospective study

Pokorná V, Pázmanová T, Kalužay J, Bobocká K, Ponťuch P

IV. interná klinika Lekárskej fakulty Univerzity Komenského a Univerzitnej nemocnice Bratislava, Nemocnica sv. Cyrila a Metoda, Bratislava, Slovenská republika

Aims: The aim of this study was to assess 1. the treatment (type of drugs, their doses, adherence to current ESH/ESC guidelines) in patients with hypertension in pregnancy; 2. the relationship between studied parameters (age, diabetes mellitus (DM), quantitative proteinuria, uric acid) and the treatment.

Methods: 233 patients, median age 32 years (interquartile range 28-35), 16% with DM, admitted to the St. Cyril and Methodius Hospital due to hypertension in pregnancy from June 2011 to June 2014, were included. The treatment was evaluated until the day of delivery. In case of serial measurements of quantitative proteinuria and uric acid, the highest ante-partum value was used.

Results: The number of drugs needed to control hypertension increased with growing age (p<0.05) and quantitative proteinuria (p<0.005). DM and uric acid showed no relationship with the number of antihypertensive drugs used. 31% patients were treated with 1 drug, 40% with 2 drugs, 21% with 3 drugs, 8 % with 4 and only 1 patient with 5 drugs. The most frequent antihypertensive drugs, their most frequent dose/day and maximum dose/day were: methyldopa (97%, 2000 mg, 2250 mg), isradipine (50%, 5 mg, 7.5 mg), intravenous (i.v.) urapidil (27%), oral urapidil (18%, 60 and 90 mg, 240 mg), metoprolol (10%, 100 mg, 125 mg), amlodipine (9%, 10 mg, 15 mg), verapamil (5%, 120 mg, 360 mg).

Conclusions: Current ESH/ESC guidelines (Management of Arterial Hypertension, 2013; Management of Cardiovascular Disease in Pregnancy, 2011) recommend the use of methyldopa, calcium antagonists and beta-blockers. In this study, the treatment was consistent with guidelines, except for urapidil. Urapidil was predominantly used in the i.v. form, as the guidelines recommended i.v. drugs for treatment of hypertension in pregnancy are not available in Slovakia. The number of drugs needed to control hypertension in pregnancy showed a correlation with increasing quantitative proteinuria and age. Most patients were concomitantly treated with 2 antihypertensive drugs. Methyldopa, isradipine and urapidil were the most frequently used drugs.

Keywords: hypertension in pregnancy; antihypertensive drugs; methyldopa; isradipine; urapidil

Published: June 1, 2015  Show citation