Choosing therapeutic tactics in pregnant women with chronic arterial hypertension: the priorities

Abstract

Aim. To evaluate the pregnancy and delivery course, as well as fetal and newborn status, while achieving optimal blood pressure (BP) levels with different regimens of antihypertensive therapy (AHT) in pregnant women with chronic arterial hypertension (AH). Material and methods. Starting from Trimester I, pregnant women received AHT, with dose titration and optimal BP achievement. Group I received chronic beta-adrenoblocker therapy (BAB), Group II – was administered BAB in Trimesters I and III, and calcium antagonists (CA) in Trimester II. Group III received CA in Trimesters I-III. The control group (CG) did not receive any AHT. Results. Optimal BP levels were achieved more often in Group II. In Group III, inadequate BP control was linked to early gestosis. In CG, systolic and diastolic BP levels (SBB, DBP) were significantly higher. DBP was normalized more often than SBP. The minimal gestosis prevalence was observed in Group II (30%). Mean delivery terms in Group II were the latest, with the best newborn status by Apgar score and the lowest prevalence of delivery complications. The CG demonstrated the worst Apgar score parameters, due to hypoxia and ischemia of central nervous system in the newborns. Group I was characterised by prevalent respiratory distress syndrome in the newborns. Higher BP levels were generally associated with worse newborns’ functional status and lower mean body weight; however, in Group II, this association was not observed. Conclusion. BP reduction to the optimal levels was safe and the most effective in rotation-based AHT (BAB+AC+BAB) among pregnant women with chronic AH.

Keywords

• хроническая артериальная гипертензия
• беременность
• β-адреноблокаторы
• антагонисты кальция