Role of maternal hemodynamics in choosing antihypertensive therapy: concept shift

DOI

https://dx.doi.org/10.18565/aig.2024.116

Muminova K.T., Ziganshina M.M., Khodzhaeva Z.S., Baranov I.I.
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Antihypertensive drugs used in pregnancy can reduce blood pressure (BP) by different mechanisms; however, none of these drugs has an advantage over the other. Due to the comparable efficacy and safety profile as outlined in national and international guidelines, the choice of antihypertensive drug in pregnancy is ultimately dependent on the doctor’s expertise, consideration of potential side effects and contraindications, availability, and cost. The risk for hypertension in pregnancy is determined by a woman’s baseline hemodynamic profile. Thus, as a rule, there is a decrease in cardiac output and increased peripheral vascular resistance in patients with preeclampsia even before pregnancy. Numerous hemodynamic studies with promising results suggest a new, phenotype-based approach to the selection of antihypertensive therapy used in pregnancy. The choice of hypotensive therapy is based on hemodynamic changes in a woman rather than on BP readings. It is recommended to prescribe a beta-blocker if cardiac output is increased (usually it is accompanied by decreased vascular resistance), but if vascular resistance is increased (usually it is accompanied by decreased cardiac output), it is recommended to prescribe a vasodilator. It is possible to correct the prescribed therapy during dynamic monitoring of its effectiveness if hemodynamic parameters normalize. This innovative concept has been shown to lead to better pregnancy outcomes, namely, faster achievement of target BP, lower incidence of severe hypertension, decreased rates of iatrogenic preterm labor and low birth weight babies.
Conclusion: Further large-scale studies are necessary to determine the optimal BP in pregnancy, as currently, there is no general consensus regarding this issue. Additionally, there is a need to investigate the efficacy of hemodynamically-based therapy for hypertension in pregnancy. This will facilitate the development of individualized therapeutic approaches.

Authors’ contributions: Muminova K.T., Ziganshina M.M., Khodzhaeva Z.S. – developing the concept and design of the study; Muminova K.T. – collecting and processing the material, writing the text; Khodzhaeva Z.S., Baranov I.I. – editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Muminova K.T., Ziganshina M.M., Khodzhaeva Z.S., Baranov I.I.
Role of maternal hemodynamics in choosing antihypertensive therapy: concept shift.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (6): 5-12 (in Russian)
https://dx.doi.org/10.18565/aig.2024.116

pregnancy

antihypertensive drugs

hemodynamic profile

cardiac output

peripheral vascular resistance

heart rate

beta-blockers

vasodilators

preeclampsia

Full text (in Russian)

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Received 15.05.2024

Accepted 30.05.2024

Kamilla T. Muminova, Junior Researcher at High Risk Pregnancy Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Academica Oparina str., 4, +7(495)438-06-74, kamika91@mail.ru
Marina M. Ziganshina, Senior Researcher at the Department of Clinical Immunology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Academica Oparina str., 4, +7(495)438-07-88, m_ziganshina@oparina4.ru
Zulfiya S. Khodzhaeva, Dr. Med. Sci., Professor, Head of High Risk Pregnancy Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Academica Oparina str., 4, +7(495)438-07-88, zkhodjaeva@mail.ru
Igor I. Baranov, Dr. Med. Sci., Professor, Head of Scientific and Educational Programs Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Academica Oparina str., 4, +7(495)438-94-92, i_baranov@oparina4.ru

Role of maternal hemodynamics in choosing antihypertensive therapy: concept shift

Muminova K.T., Ziganshina M.M., Khodzhaeva Z.S., Baranov I.I.

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