2008, Number 04
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Ginecol Obstet Mex 2008; 76 (04)
Chronic high blood pressure in 110 pregnant women
Iñigo RCA, Torres GLG, Vargas GA, Angulo VJ, Espinoza OMA
Language: Spanish
References: 22
Page: 202-210
PDF size: 178.26 Kb.
ABSTRACT
Background: Hypertension is associated with increased maternal and fetal mortality and morbidity. While there is consensus that severe hypertension should be treated, antihypertensive treatment for mild chronic hypertension during pregnancy remains controversial.
Objective: To evaluate clinical course, and maternal and perinatal outcomes of pregnant women with mild chronic hypertension without other disease, under strict control of maternal hypertension (target dBP of 85-89 mmHg).
Patients and methods: We conducted a prospective cohort study of 110 pregnant women with mild chronic hypertension without other disease; clinical course was classified in three groups: stable condition, exacerbation of hypertension and superimposed preeclampsia. We compare maternal and perinatal outcomes; statistical comparisons were performed by ANOVA test. Relative risk (RR) was calculated for adverse perinatal outcomes.
Results: A total of 110 women were included, mean maternal age was 33 ± 5.8 years. There were 78 (71%) women with stable condition, 26 (24%) with exacerbation of hypertension and 6 (5%) with superimposed preeclampsia (PE). Women with superimposed PE and exacerbation of hypertension delivered earlier and had more small for gestational age (SGA) babies than women with stable condition and exacerbation. Delivery route was vaginal in 45 patients (40%) while 65 patients (60%) underwent cesarean section in order to avoid fetal distress.
Conclusions: Results demonstrated that fetuses in the stable condition group (strict control) did not have worst outcomes than those in the other groups. This cohort study shows efficacy and safety of treating mild chronic hypertension during pregnancy.
REFERENCES
Zetterström K, Lindeberg SN, Haglund B, Hanson U. Maternal complications in women with chronic hypertension: a population-based cohort study. Acta Obstet Gynecol Scand 2005;84:419-24.
James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart 2004;90:1499-504.
Ruiz AJ, Castelazo ME, Suárez del Puerto H, Martínez MF, Álvarez VJ, Bolaños AR. Resultados perinatales en pacientes con hipertensión arterial sistémica crónica en el Instituto Nacional de Perinatología. Ginecol Obstet Mex 2001;69:143.
Sibai BM. Hipertensión crónica durante el embarazo. Clin Perinatología 1991;4:813-52.
Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002;100:369-77.
Zetterström K, Lindberg SN, Haglund B, Hanson U. Chronic hypertension as a risk factor for offspring to be born small for gestational age. Acta Obstet Gynecol 2006;85:1046-50.
Handler J. Managing chronic severe hypertension in pregnancy. J Clin Hypertension 2006;8(10):738-43.
Velázquez MO, Rosas PM, Lara EA, Pastelín HG, Grupo ENSA 2000, et al. Hipertensión arterial en México: Resultados de la Encuesta Nacional de Salud (ENSA) 2000. Arch Inst Cardiol Mex 2002;72:71-84.
Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol 1994;171:410-61.
Ananth CV, Peltier MR, Kinzler WL, Smulian C, Vintzileos AM. Chronic hypertension and risk of placental abruption: is the association modified by ischemic placental disease? Am J Obstet Gynecol 2007;197:273.e1-273.e7.
McCowan LM, Buist RG, North RA, Gamble G. Perinatal morbidity in chronic hypertension. Br J Obstet Gynaecol 1996;103:123-9.
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1-S22.
Neerhof MG. Embarazo en la paciente con hipertensión crónica. Clin Perinatología 1997;2:409-24.
Arias F, Zamora J. Antihypertensive teatment and pregnancy outcome in patients with mild chronic hypertension. Obstet Gynecol 1979;53:489-94.
Sibai BM, Abdella TN, Anderson GD. Pregnancy outcome in 211 patients with mild chronic hypertension. Obstet Gynecol 1983;61:571-6.
Mabie WC, Pernillo ML, Biswas MK. Chronic hypertension in pregnancy. Obstet Gynecol 1986;67:197-205.
Magee L, von Dadelszen P, Chan S, Gafni A et al., for the Chips Pilot Trial Collaborative Group. The CHIPS (Control of Hypertension In Pregnancy Study) pilot trial. BJOG 2007;114:770-e20.
Vigil-De Garcia P, Lasso M, Montufar-Rueda C. Perinatal outcome in women with severe chronic hypertension during the second half of pregnancy. Int J Gynaecol Obstet 2004;85:139-44.
Haelterman E, Bréat G, Paris-Llado J, Dramaix M, Tchobroutsky. Effect of uncomplicated chronic hypertension on the risk of small-for-gestational age birth. Am J Epidemiol 1997;145:689-95.
Arias F. Guía practica para el embarazo y el parto de alto riesgo. 2ª ed. México: Mosby-Doyma, 1995;p:234.
Calderón GJ, Vega MG, Velásquez TJ, Morales CR, Vega MA. Factores de riesgo materno asociados al parto pretérmino. Rev Med IMSS 2005;43(4):339-47.
López-Llera M. Hipertensión arterial crónica y embarazo. Análisis de estudios clínicos. Ginecol Obstet Mex 1990;58:70-77.