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ISSN 1561-3062 (Electronic)

2018, Number 2

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Revista Cubana de Obstetricia y Ginecología 2018; 44 (2)

Evaluation of pharmacological treatment in patients with chronic hypertension associated with pregnancy

Suárez GJA, Ojeda BJC, Gutiérrez MM, Luis MP, Bouza JD

Language: Spanish
References: 20
Page: 1-10
PDF size: 367.76 Kb.


ABSTRACT

Introduction: The diagnosis of chronic hypertension during pregnancy is difficult in a patient who does not report a history of hypertension.
Objective: To characterize the management of these patients from the pharmacological point of view.
Method: A retrospective descriptive study was carried out on the use of medications, indication-prescription type, from 2015 to 2017. Six hundred eighty seven (687) pregnant women with chronic arterial hypertension was the universe of this study. These subjects are from Villa Clara and were patients of the consultation of hypertension and pregnancy at Mariana Grajales Gynecobstetric Hospital in Santa Clara. Two hundred forty two (242) patients were select to form the sample by simple random sampling that represented 35.2% of the study universe.
Results: In similar proportion, we found patients with hypertension before pregnancy and diagnosed in the first 22 weeks. In both groups, the main risk factors were pregestational obesity in 79% and cardio metabolic risk in 74.4%. Monotherapy predominated in the evaluation of the pharmacological treatment of these patients. There was a readjustment of the initial doses. The treatments indicated in the primary health care were modified. In general, the evaluation of the treatment was inadequate in the majority of the cases.
Conclusions: Patients with chronic hypertension associated with pregnancy have risk factors for preeclampsia-eclampsia. Pregestational obesity and cardiometabolic risk are also contributing risks. The majority of patients (104) required monotherapy. In addition, they have taken treatments that have required reorganization in subsequent consultations. The evaluation of the treatment was inadequate in most cases.


REFERENCES

  1. Seely EW, Ecker J. Chronic hypertension in pregnancy. N Engl J Med. 2011[citado 22 jul 2017];365:439-46. Disponible en: http://www.enotes.tripod.com/Hypertension_pregnancy2011.pdf

  2. Bramham K, Briley A, Seed P, Poston L, Shennan A, Chappell L. Adverse maternal and perinatal outcomes in women with previous preeclampsia: a prospective study. Am J Obstet Gynecol. 2011[citado 22 jul 2017];204. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21457915

  3. Zhang S, Meikle A. Trumble Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States Hypertens Pregnancy. 2003 [citado 7 febrero 2018];22:203-12. Disponible en: http://dx.doi.org/10.1081/PRG-120021066

  4. Catov RB, Ness KE, Kip J. Olsen Risk of early or severe pre-eclampsia related to preexisting conditions Int J Epidemiol. 2007[citado 4 enero 2018];36:412-9. Disponible en: http://dx.doi.org/10.1093/ije/dyl271

  5. Menzies LA, Magee J, Li YC, Macnab R, Yin H. Stuart Instituting surveillance guidelines and adverse outcomes in preeclampsia Obstet Gynecol. 2007[citado 16 enero 2018];110:121-7. Disponible en: http://dx.doi.org/10.1097/01.AOG.0000266977.26311.f0

  6. Haddad BM. Sibai Expectant management in pregnancies with severe pre-eclampsia. Semin Perinatol. 2009[citado 5 febrero 2018];33:143-51. Disponible en: http://dx.doi.org/10.1053/j.semperi.2009.02.002

  7. Conde-Agudelo M. Lindheimer Use of Doppler ultrasonography to predict preeclampsia CMAJ. 2008[citado 16 enero 2018];179:53-4. Disponible en: http://dx.doi.org/10.1503/cmaj.1080039

  8. Levine SE, Maynard C, Qian KH, Lim LJ, England Kg F. Yu Circulating angiogenic factors and the risk of preeclampsia NEJM. 2004 [citado 16 enero 2018];350:672-83. Disponible en: http://dx.doi.org/10.1056/NEJMoa031884

  9. Consenso latinoamericano sobre hipertensión arterial. J Hypertension. 2001[citado 16 enero 2018];6(2):1-28. Disponible en: http://www.sac.org.ar/files/files/cc_latam_hta.pdf

  10. Aardema H, Oosterhof A, Timmer RI, Van JG. Aarnoudse Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses Placenta. 2001[citado 6 diciembre 2017];22:405-411. Disponible en: http://dx.doi.org/10.1053/plac.2001.0676

  11. Meler F, Figueras M, Bennasar O, Gomez F, Crispi E. Gratacos The prognostic role of uterine artery Doppler investigation in patients with severe early-onset preeclampsia Am J Obstet Gynecol. 2010[citado 12 febrero 2018];202:559.e1-559.e4. Disponible en: http://dx.doi.org/10.1016/j.ajog.2010.01.048

  12. Maynard SE, Karumanchi A. Angiogenic factors and pre-eclampsia. Semin Nephrol. 2011[citado 12 marzo 2018];31:33-46. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063446/

  13. Pena-Rosas JP, Casanova E. Suplementación de calcio durante el embarazo para prevenir los trastornos hipertensivos y problemas relacionados. Biblioteca de Salud Reproductiva de la OMS No. 12. Ginebra: OMS, 2009 [citado 12 marzo 2018]. Disponible en: http://www.bibliotecacochrane.com/control2.php?URL=/PDFES/CD001059.pdf

  14. Mongraw-Chaffin ML, Cirillo PM, Cohn BA. Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort. Hypertension. 2010[citado 12 marzo 2018];56:166-71. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/20516394

  15. Sunderji E, Gaziano D, Wothe LC, Rogers B, Sibai SA. Karumanchi Automated assays for sVEGF R1 and PlGF as an aid in the diagnosis of preterm preeclampsia: a prospective clinical study Am J Obstet Gynecol. 2010[citado 12 febrero 2018];202:40.e1-40.e7. Disponible en: http://dx.doi.org/10.1016/j.ajog.2010.03.022 .

  16. Verlohren A, Galindo D, Schlembach H, Zeisler I, Herraiz MG. Moertl An automated method for the determination of the sFlt-1/PIGF ratio in the assessment of preeclampsia Am J Obstet Gynecol. 2010[citado 12 febrero 2018];202:161.e1-161.e11. Disponible en: http://dx.doi.org/10.1016/j.ajog.2009.09.016 .

  17. Suárez González JA, Gutiérrez Machado M. Predictores de la preeclampsia/eclampsia en un grupo de gestantes de alto riesgo. Rev Cubana Obstet Ginecol. 2011;37(2):154-61.

  18. Robyn A North, Lesley ME McCowan, Gustaaf A Dekker, Lucilla Poston. Predicción del riesgo de preeclampsia en nulíparas. BMJ. 2011;342:d1875.

  19. Young RJ, Levine S, Salahuddin C, Qian KH, Lim SA. Karumanchi The use of angiogenic biomarkers to differentiate non-HELLP related thrombocytopenia from HELLP síndrome J Matern Fetal Neonatal Med. 2010[citado 23 diciembre 2017];23:366-70. Disponible en: http://dx.doi.org/10.1080/14767050903184207

  20. Gilbert J, Verzwyvelt D, Colson M, Arany SA, Karumanchi JP. Granger Recombinant vascular endothelial growth factor 121 infusion lowers blood pressure and improves renal function in rats with placental ischemia-induced hypertension. Hypertension. 2010;55:380-5.




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