Research progress on the treatment and medication safety of hypertensive disorders during pregnancy
HE Xin ZHI Juan
Department of Pharmacy, Women′s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Jiangsu Province, Nanjing 210004, China
Hypertensive disorders during pregnancy (HDP) represent a major cause of maternal, fetal and neonatal mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. Treatment of HDP concerns both the mother and the fetus and depends on blood pressure (BP) level, gestational age, and presence of associated maternal and fetal risk factors. This article reviews the effect of antihypertensive drugs on mother and fetus when administered during pregnancy and/or post-partum. Treatment of mild hypertension and no end-organ damage during pregnancy remains controversial and there is no agreement about when to initiate antihypertensive therapy, optimal BP targets or recommended drugs. In severe hypertension the goal is to reduce BP to ＜160/105 mmHg over minutes to hours and then to achieve a sustained BP of 140-150/90-100 mmHg, and most guidelines recommend antihypertensive therapy with labetalol, methyldopa, or nifedipine. Nifedipine, labetalol and some angiotensin-converting enzyme inhibitors (captopril and enalapril) can be used safely during breastfeeding. This review could provide clinical references for treating HDP patients safety and effectively by describing antihypertensive drugs in details.
何 心；支 娟 . 妊娠高血压综合征的治疗及用药安全性的研究进展[J]. 中国当代医药, 2022, 29(26): 40-43转47.
HE Xin ZHI Juan. Research progress on the treatment and medication safety of hypertensive disorders during pregnancy. 中国当代医药, 2022, 29(26): 40-43转47.
Regitz-Zagrosek V，Roos-Hesselink JW，Bauersachs J，et al.2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy[J].Eur Heart J，2018，39（34）：3165-3241.
[5]
Brown MA，Magee LA，Kenny LC，et al.Hypertensive Disorders of Pregnancy：ISSHP Classification，Diagnosis，and Management Recommendations for International Practice[J].Hypertension，2018，72（1）：24-43.
[6]
Cleary KL，Siddiq Z，Ananth CV，et al.Use of Antihypertensive Medications During Delivery Hospitalizations Complicated by Preeclampsia[J].Obstet Gynecol，2018，131（3）：441-450.
[7]
Whelton PK，Carey RM，Aronow WS，et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention，Detection，Evaluation，and Management of High Blood Pressure in Adults[J].J Am Coll Cardiol，2018，71（19）：e127-e248.
[8]
Espinoza J，Vidaeff A，Pettker CM，et al.ACOG Practice Bulletin No.222：Gestational Hypertension and Preeclampsia[J].Obstet Gynecol，2020，135（6）：e237-e260.
[9]
Bateman BT，Heide-Jorgensen U，Einarsdottir K，et al.Beta-Blocker Use in Pregnancy and the Risk for Congenital Malformations：An International Cohort Study[J].Ann Intern Med，2018，169（10）：665-673.
[10]
Abalos E，Duley L，Steyn DW，et al.Antihypertensive drug therapy for mild to moderate hypertension during pregnancy[J].Cochrane Database Syst Rev，2018，10：CD002252.
[11]
Cifkova R，Johnson MR，Kahan T，et al.Peripartum management of hypertension：a position paper of the ESC Council on Hypertension and the European Society of Hypertension[J].Eur Heart J Cardiovasc Pharmacother，2020，6（6）：384-393.
[12]
ACOG.Committee opinion No.767：emergent therapy for acute-onset，severe hypertension during pregnancy and the postpartum period[J].Obstet Gynecol，2019，133（2）：e174-e180.
[13]
Foo L，Tay J，Lees CC，et al.Hypertension in pregnancy：natural history and treatment options[J].Curr Hypertens Rep，2015，17（5）：36.
[14]
Espinoza J，Vidaeff A，Pettker CM，et al.ACOG Practice Bulletin No.202：Gestational Hypertension and Preeclampsia[J].Obstet Gynecol，2019，133（1）：e1-e25.
[15]
Duley L，Meher S，Jones L.Drugs for treatment of very high blood pressure during pregnancy （Review）[J].Cochrane Database Syst Rev，2013，31（7）：CD001449.
[16]
Thakur M，Gainder S，Saha SC，et al.To study the changes in maternal hemodynamics with intravenous labetalol or nifedipine in acute severe hypertension[J].Pregnancy Hypertens，2020，21：180-183.
[17]
Bellos I，Pergialiotis V，Papapanagiotou A，et al.Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension：a network meta analysis[J].Am J Obstet Gynecol，2020，223（4）：525-537.
[18]
Lowe SA，Bowyer L，Lust K，et al.The SOMANZ Guidelines for the Management of Hypertensive Disorders of Pregnancy 2014[J].Aust N Z J Obstet Gynaecol，2015，55（1）：11-16.
[19]
Orbach H，Matok I，Gorodischer R，et al.Hypertension and antihypertensive drugs in pregnancy and perinatal outco mes[J].Am J Obstet Gynecol，2013，208（4）：e301-e306.
[20]
Vest AR，Cho LS.Hypertension in pregnancy[J].Curr Atheroscler Rep，2014，16（3）：395.
Sridharan K，Sequeira RP.Drugs for treating severe hypertension in pregnancy：a network meta-analysis and trial sequential analysis of randomized clinical trials[J].Br J Clin Pharmacol，2018，84（9）：1906-1916.
[23]
Behrens I，Basit S，Melbye M，et al.Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy：nationwide cohort study[J].BMJ，2017，358：j3078.
[24]
ACOG.Hypertension in pregnancy.Report of the American college of obstetricians and gynecologists′task force on hypertension in pregnancy[J].Obstet Gynecol，2013，122（5）：1122-1131.
[25]
Pucci M，Sarween N，Knox E，et al.Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in women of childbearing age：risks versus benefits[J].Expert Rev Clin Pharmacol，2015，8（2）：221-231.
[26]
Ke AB，Rostami-Hodjegan A，Zhao P，et al.Pharmacometrics in pregnancy：An unmet need[J].Annu Rev Pharmacol Toxi col，2014，54：53-69.
京公网安备 11010502046607号