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Ehikioya E, Okobi OE, Beeko MAE, Abanga R, Abah NNI, Briggs L, Nwimo PN, Beeko PKA, Nwachukwu OB, Okoroafor CC. Comparing Intravenous Labetalol and Intravenous Hydralazine for Managing Severe Gestational Hypertension. Cureus 2023; 15:e42332. [PMID: 37614273 PMCID: PMC10443893 DOI: 10.7759/cureus.42332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
Background Hypertensive disorders of pregnancy are the leading causes of both maternal morbidity and maternal mortality. Hypertensive disorders are acute obstetric emergencies, which refer to various life-threatening medical challenges known to develop during pregnancy, labor, and delivery, requiring urgent attention to reduce blood pressure (BP) for the benefit of the affected mothers and infants. Hydralazine and labetalol have been widely used as the first-line medications in the management of severe hypertension during pregnancy. However, the choice between these two drugs lacks clear evidence regarding their safety and superiority. Several studies have attempted to study intravenous (IV) labetalol versus hydralazine, but very few such comparison studies have been conducted in Africa. Objective To compare the effectiveness of IV labetalol and IV hydralazine in reducing systolic and diastolic BP in pregnant women with severe hypertension. Also, to determine the time required for hydralazine and labetalol to lower BP to ≤150/100 mmHg, the number of doses needed for each drug, and evaluating maternal and perinatal outcomes. Study design This study employed an open-label randomized clinical trial design conducted in the labor, delivery, and antenatal ward of the Central and Stella Obasanjo Hospital in Benin City. A total of 120 women with severe pregnancy-induced hypertension were randomly assigned to two groups: Group X, consisting of 60 pregnant women, received IV hydralazine at a slow rate of 5 mg for five minutes, repeated every 20 minutes (maximum of five doses) until a blood pressure of ≤150/100 mmHg was achieved. Group Y, also consisting of 60 pregnant women, received IV labetalol in escalating doses of 25, 50, 75, 75, and 75 mg (maximum of 300 mg) every 20 minutes until the blood pressure reached ≤150/100 mmHg. Statistical analysis was performed using SPSS version 23 (IBM Inc., Armonk, New York). Result IV hydralazine achieved the target BP in an average time of 45.80 +/- 25.17 minutes, while IV labetalol took an average of 72.67 +/- 41.80 minutes (p=0.001). The number of doses required to reach the target BP differed significantly between the two drugs. Hydralazine required an average of 1.72 +/- 0.904 doses, whereas labetalol required an average of 3.72 +/- 1.782 doses (p=0.0001). While 45% of women in the hydralazine group attained the target BP with a single dose of hydralazine, only 31.1% of women in the labetalol group were able to attain the target BP with a single dose of labetalol (p=0.02). Overall, target BP was achieved in 55 out of 60 women (91.7%) who were randomized to receive IV hydralazine, whereas 45 out of 60 women (75%) who received IV labetalol achieved the target blood pressure. While hydralazine demonstrated more favorable results in terms of achieving target blood pressure, there were higher incidences of maternal adverse effects in the hydralazine group compared to the labetalol group. However, these adverse effects were not severe enough to warrant discontinuation of the medication. Conclusion IV hydralazine showed faster achievement of the target BP and a lower number of doses required compared to IV labetalol. Additionally, a higher percentage of women in the hydralazine group achieved the target BP with a single dose. However, there were more maternal adverse effects associated with hydralazine, although they were not severe. Perinatal outcomes did not differ significantly between the two groups.
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Affiliation(s)
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Rafia Abanga
- Obstetrics and Gynecology, Weija Gbawe Municipal Hospital, Accra, GHA
| | | | - Lilian Briggs
- Internal Medicine, Grodno State Medical University, Belarus, AUS
| | - Patience N Nwimo
- Internal Medicine, First Foundation Medical Clinic, Loganville, USA
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Coursen J, Simpson CE, Mukherjee M, Vaught AJ, Kutty S, Al-Talib TK, Wood MJ, Scott NS, Mathai SC, Sharma G. Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension. J Cardiovasc Dev Dis 2022; 9:jcdd9080260. [PMID: 36005424 PMCID: PMC9409449 DOI: 10.3390/jcdd9080260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.
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Affiliation(s)
- Julie Coursen
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Catherine E. Simpson
- Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Arthur J. Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology Obstetrics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Shelby Kutty
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Tala K. Al-Talib
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Malissa J. Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nandita S. Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stephen C. Mathai
- Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Correspondence:
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Abstract
Hypertensive diseases of pregnancy remain a leading cause of maternal and neonatal morbidity and mortality. Therefore, we sought to review the management of these conditions in pregnancy. In this review we discuss the most updated definitions, different antihypertensives, delivery recommendations and overall goals of management, including their effects on uteroplacental perfusion. We also highlight different medical situations where one antihypertensive may be preferable over others.
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Affiliation(s)
- Farah Amro
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Baha Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Obadeji ST, Obadeji A, Bamidele JO, Ajayi FT. Medication use among pregnant women at a secondary health institution: utilisation patterns and predictors of quantity. Afr Health Sci 2020; 20:1206-1216. [PMID: 33402967 PMCID: PMC7751527 DOI: 10.4314/ahs.v20i3.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the lack of adequate studies on the safety of drugs in pregnancy, surprisingly, available evidence shows that pregnant women still take large number of drugs. OBJECTIVES The study aim was to determine drug utilization pattern and predictors of number of medications used by pregnant women. METHODS This was a cross-sectional survey of 369 pregnant women attending a secondary health facility. Data were collected using interviewer-administered questionnaire. Descriptive and inferential statistics using the Chi-Square test were carried out with level of significance set at p<0.05. RESULTS Three hundred and sixty-nine women were interviewed. Their mean age was 27.7 years (SD± 4.78) and the mean number of pregnancies was 2.46 (SD± 1.34). On average, 2.62 medications were taken, with the lowest being 1 and the highest being 12 different medications during the course of pregnancy. Those who were on more than 2 medications were more likely to be older than 30 years, had lower education and with history of associated medical conditions. All participants were on one form of supplements or the other, nearly half had used antimalarials, 12.8%, 5.8% 2.4% were on antibiotics, anti-hypertensive and anti-retroviral medications respectively. All the medications prescribed were from category A, B, C, N, and none from category D and X. CONCLUSION Varieties of medications were used during the course of pregnancy among this population, however, most of these drugs were still within safety profile.
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Affiliation(s)
- Stella T Obadeji
- Department of Pharmacy State Hospital, Ijaye, Abeokuta, Ogun State, Nigeria
| | - Adetunji Obadeji
- Department of Psychiatry/Pharmacology, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Janet O Bamidele
- Department of community medicine and Primary care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun state
| | - Felix T Ajayi
- Department of Pharmacy, Federal Medical Centre, Ijaye, Abeokuta, Ogun State, Nigeria
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Naito T. Optimization of Individual Pharmacotherapy Based on Multiple Evaluations of Patient Data. Biol Pharm Bull 2019; 42:149-157. [DOI: 10.1248/bpb.b18-00766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Takafumi Naito
- Department of Hospital Pharmacy, Hamamatsu University Hospital, Hamamatsu University School of Medicine
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Martínez-Rodríguez JE, Camacho-Yacumal A, Unigarro-Benavides LV, Nazareno DY, Fernández-Pabón J, Burbano-Imbachí A, Cardona-Gómez DC, Cedeño-Burbano AA. Anestesia para pacientes con preeclampsia. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.65756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La preeclampsia es una enfermedad con alta frecuencia a nivel mundial relacionada con la gestación. Las pacientes que la padecen pueden precisar un procedimiento anestésico por diversos motivos, incluidas las complicaciones graves.Objetivo. Realizar una revisión narrativa de la literatura respecto a las pautas principales del tratamiento anestésico de pacientes con preeclampsia.Materiales y métodos. Se realizó una búsqueda estructurada en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos Anesthesia AND pre-eclampsia AND therapeutics; hypertension, Pregnancy-Induced AND anesthesia AND therapeutics; anesthesia AND pre-eclampsia; hypertension, pregnancy induced AND anesthesia. La búsqueda se hizo en inglés con sus equivalentes en español.Resultados. Se encontraron 61 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. Una valoración preanestésica y la instauración temprana de las técnicas analgésicas y anestésicas pueden mitigar el impacto de complicaciones derivadas del curso de la preeclampsia. Respecto a desenlaces mayores, no existe diferencia significativa entre los distintos tipos de anestesia.
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Pharmacological Effect of Quercetin in Hypertension and Its Potential Application in Pregnancy-Induced Hypertension: Review of In Vitro, In Vivo, and Clinical Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:7421489. [PMID: 30622610 PMCID: PMC6304490 DOI: 10.1155/2018/7421489] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 01/27/2023]
Abstract
Since improving maternal and child health is a public health priority worldwide, the main aim of treatment of hypertension in pregnant women is to prevent complications during pregnancy, labor, and postpartum. In consequence, much attention is paid to the use of antihypertensive drugs that can be used safely during pregnancy. Several side effects of methyldopa, which is currently the most commonly used antihypertensive drug in pregnant women, mean that the search for an effective and safe alternative still continues. Flavonoid compounds present in medicinal plants, vegetables, and fruits may be a promising source of new drugs. In this aspect, quercetin, a well-known flavonoid due to its antihypertensive action, may be considered a prototype for safe antihypertensive drugs. This review focuses on the selective activity of quercetin. Based on recent studies, a few problems were discussed, including (1) pathology of pregnancy-induced hypertension; (2) search for new pharmacological treatments of pregnancy-induced hypertension; (3) issues with the use of herbal extracts during pregnancy; (4) flavonoids as natural active chemical compounds; (5) quercetin: its action during pregnancy, in vitro and in vivo pharmacological activities, clinical trials, and meta-analysis; (6) quercetin intake during pregnancy; (7) other natural compounds tested during pregnancy; (8) potential problems with the use of quercetin; (9) safety profile of quercetin. Various studies have shown a beneficial effect of quercetin on vascular endothelial function and its antioxidative and anti-inflammatory activity on cellular and tissue level. It is known that in animal models quercetin affects positively the development of embryo, fetus, and placenta. Because this flavonoid did not have teratogenic and abortive effect, it is generally recognized as safe. For this reason it should be appreciated and studied in the aspect of its potential use in the prevention and treatment of pregnancy-induced hypertension among women in this risk group.
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Sridharan K, Sequeira RP. Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol 2018; 84:1906-1916. [PMID: 29974489 PMCID: PMC6089822 DOI: 10.1111/bcp.13649] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/29/2022] Open
Abstract
AIMS Several antihypertensive drugs are used in the treatment of severe hypertension in pregnancy. The present study is a network meta-analysis comparing the efficacy and safety of these drugs. METHODS Electronic databases were searched for randomized clinical trials comparing drugs used in the treatment of severe hypertension in pregnancy. The number of women achieving the target blood pressure (BP) was the primary outcome. Doses required and time taken for achieving the target BP, failure rate, and incidences of maternal tachycardia, palpitation, hypotension, headache, and neonatal death and stillbirth were the secondary outcomes. Mixed treatment comparison pooled estimates were generated using a random-effects model. Odds ratios for the categorical and mean difference for the numerical outcomes were the effect estimates. RESULTS Fifty-one studies were included in the systematic review and 46 in the meta-analysis. No significant differences in the number of patients achieving target BP was observed between any of the drugs. Diazoxide [-15 (-20.6, -9.4)], nicardipine [-11.8 (-22.3, -1.2)], nifedipine/celastrol [-19.3 (-27.4, -11.1)], nifedipine/vitamin D [-17.1 (-25.7, -9.7)], nifedipine/resveratrol [-13.9 (-22.6, -5.2)] and glyceryl trinitrate [-33.8 (-36.7, -31)] were observed to achieve the target BP (in minutes) more rapidly than hydralazine. Nifedipine required fewer doses than hydralazine for achieving the target BP. Glyceryl trinitrate and labetalol were associated with fewer incidences of tachycardia and palpitation respectively than hydralazine. Trial sequential analysis concluded adequate evidence for hydralazine and nifedipine compared with labetalol. Moderate quality of evidence was observed for direct comparison estimate between labetalol and hydralazine but was either low or very low for other comparisons. CONCLUSION The present evidence suggests similar efficacy between nifedipine, hydralazine and labetalol in the treatment of severe hypertension in pregnancy. Subtle differences may exist in their safety profile. The evidence is inadequate for other drugs.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical SciencesArabian Gulf UniversityManamaBahrain
| | - Reginald P. Sequeira
- Department of Pharmacology and Therapeutics, College of Medicine and Medical SciencesArabian Gulf UniversityManamaBahrain
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Perschbacher KJ, Deng G, Fisher RA, Gibson-Corley KN, Santillan MK, Grobe JL. Regulators of G protein signaling in cardiovascular function during pregnancy. Physiol Genomics 2018; 50:590-604. [PMID: 29702036 PMCID: PMC6139632 DOI: 10.1152/physiolgenomics.00037.2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
G protein-coupled receptor signaling mechanisms are implicated in many aspects of cardiovascular control, and dysfunction of such signaling mechanisms is commonly associated with disease states. Investigators have identified a large number of regulator of G protein signaling (RGS) proteins that variously contribute to the modulation of intracellular second-messenger signaling kinetics. These many RGS proteins each interact with a specific set of second-messenger cascades and receptor types and exhibit tissue-specific expression patterns. Increasing evidence supports the contribution of RGS proteins, or their loss, in the pathogenesis of cardiovascular dysfunctions. This review summarizes the current understanding of the functional contributions of RGS proteins, particularly within the B/R4 family, in cardiovascular disorders of pregnancy including gestational hypertension, uterine artery dysfunction, and preeclampsia.
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Affiliation(s)
| | - Guorui Deng
- Department of Pharmacology, University of Iowa , Iowa City, Iowa
| | - Rory A Fisher
- Department of Pharmacology, University of Iowa , Iowa City, Iowa
| | - Katherine N Gibson-Corley
- Department of Pathology, University of Iowa , Iowa City, Iowa
- UIHC Center for Hypertension Research, University of Iowa , Iowa City, Iowa
| | - Mark K Santillan
- Department of Obstetrics & Gynecology, University of Iowa , Iowa City, Iowa
- UIHC Center for Hypertension Research, University of Iowa , Iowa City, Iowa
- Abboud Cardiovascular Research Center, University of Iowa , Iowa City, Iowa
| | - Justin L Grobe
- Department of Pharmacology, University of Iowa , Iowa City, Iowa
- UIHC Center for Hypertension Research, University of Iowa , Iowa City, Iowa
- Abboud Cardiovascular Research Center, University of Iowa , Iowa City, Iowa
- Fraternal Order of Eagles' Diabetes Research Center, University of Iowa , Iowa City, Iowa
- Obesity Education & Research Initiative, University of Iowa , Iowa City, Iowa
- Iowa Neuroscience Institute, University of Iowa , Iowa City, Iowa
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Teperino R. Anti-hypertensive treatment in pregnancy impacts offspring growth and metabolism: Q&A. Mol Metab 2017; 6:1079-1080. [PMID: 29031709 PMCID: PMC5641627 DOI: 10.1016/j.molmet.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Raffaele Teperino
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany; German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany.
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Cedeño Burbano AA, Galeano Triviño GA, Fernández Bolaños DA, Chito castro KL, Coronado Abella V. Hipertensión postparto: Una revisión de la literatura y los protocolos de manejo. REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v63n2.48001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p><strong>Introducción: </strong>La hipertensión postparto corresponde a la presencia de cifras tensionales sistólicas superiores a 140 mmHg o diastólicas mayores a 90 mmHg, medidas en 2 ocasiones con una diferencia de 4 horas; las cuales aparecen o se sostienen en el puerperio, hasta las 12 semanas posteriores al nacimiento (1,2). Los trastornos hipertensivos del embarazo que aparecen o se continúan en el puerperio son en conjunto su principal etiología. La incidencia mundial de la hipertensión postparto oscila entre 3 y 26%, mientras que su prevalencia, no del todo establecida, oscila entre el 0,3 y el 28% (3,4). Actualmente, a excepción de la crisis hipertensiva, el manejo de la hipertensión en el posparto no está estandarizado. <strong>Objetivo:</strong> Realizar una revisión bibliográfica acerca del manejo de la hipertensión postparto. Se excluyó el abordaje de la crisis hipertensiva, ya que existen estándares bien definidos para el manejo de dicha condición. <strong>Metodología:</strong> Se realizó una búsqueda de la literatura publicada en los últimos 5 años en las bases de datos: Pubmed, Tripdatabase, Science Direct y Embase biomedical, con los términos: postpartum, hypertension, postpartum hypertension and diagnsosis, postpartum hypertension and treatment, postpartum hypertension and management; en inglés y con sus equivalentes en español.</p><p><strong>Conclusiones: </strong>No existe evidencia para el manejo de la hipertensión postparto leve a moderada. En hipertensión postparto severa, el manejo farmacológico depende de la experticia y familiaridad que el médico tratante tenga respecto a la utilización del fármaco.</p><p><strong>Palabras clave:</strong> Hipertensión postparto, pre-eclampsia postparto, manejo, tratamiento. </p>
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Abstract
Cardiovascular disease (CVD) is the leading health threat to American women. In addition to establish risk factors for hypertension, hyperlipidemia, diabetes, smoking, and obesity, adverse pregnancy outcomes (APOs) including pre-eclampsia, eclampsia, and gestational diabetes are now recognized as factors that increase a woman's risk for future CVD. CVD risk factor burden is disproportionately higher in those of low socioeconomic status and in ethnic/racial minority women. Since younger women often use their obstetrician/gynecologist as their primary health provider, this is an opportune time to diagnose and treat CVD risk factors early. Embedding preventive care providers such as nurse practitioners or physician assistants within OB/GYN practices can be considered, with referral to family medicine or internist for ongoing risk assessment and management. The American Heart Association (AHA)/American Stroke Association (ASA) stroke prevention guidelines tailored to women recommend that women with a history of pre-eclampsia can be evaluated for hypertension and other CVD risk factors within 6 months to 1-year post-partum. Given the burden and impact of CVD on women in our society, the entire medical community must work to establish feasible practice and referral patterns for assessment and treatment of CVD risk factors.
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Affiliation(s)
- Puja K Mehta
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 S San Vicente Blvd, AHSP3600, Los Angeles, CA 90048
| | - Margo Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 S San Vicente Blvd, AHSP3600, Los Angeles, CA 90048
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 S San Vicente Blvd, AHSP3600, Los Angeles, CA 90048; Women's Guild Endowed Chair in Women's Health, Cedars-Sinai Heart Institute, Los Angeles, CA; Preventive Cardiac Center, Cedars-Sinai Heart Institute, Los Angeles, CA; Department of Medicine, Cedars-Sinai Heart Institute, Los Angeles, CA.
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de Picoli Souza K, da Silva ED, Batista EC, Reis FCG, Silva SMA, Castro CHM, Luz J, Pesquero JL, Dos Santos EL, Pesquero JB. Early pharmacological inhibition of angiotensin-I converting enzyme activity induces obesity in adulthood. Front Pharmacol 2015; 6:75. [PMID: 25926796 PMCID: PMC4396349 DOI: 10.3389/fphar.2015.00075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/19/2015] [Indexed: 01/05/2023] Open
Abstract
We have investigated early programming of body mass in order to understand the multifactorial etiology of obesity. Considering that the renin-angiotensin system (RAS) is expressed and functional in the white adipose tissue (WAT) and modulates its development, we reasoned whether early transitory inhibition of angiotensin-I converting enzyme activity after birth could modify late body mass development. Therefore, newborn Wistar rats were treated with enalapril (10 mg/kg of body mass) or saline, starting at the first day of life until the age of 16 days. Between days ninetieth and hundred and eightieth, a group of these animals received high fat diet (HFD). Molecular, biochemical, histological, and physiological data were collected. Enalapril treated animals presented hyperphagia, overweight, and increased serum level of triglycerides, total cholesterol and leptin, in adult life. Body composition analyses revealed higher fat mass with increased adipocyte size in these animals. Molecular analyses revealed that enalapril treatment increases neuropeptide Y (NPY) and cocaine- and amphetamine-regulated transcript (CART) gene expression in hypothalamus, fatty acid synthase (FAS), and hormone-sensitive lipase (HSL) gene expression in retroperitoneal WAT, and decreases peroxixome proliferators-activated receptor (PPAR)γ, PPARα, uncoupling protein (UCP)2, and UCP3 gene expression in WAT. The results of the current study indicate that enalapril administration during early postnatal development increases body mass, adiposity and serum lipids in adulthood associated with enhanced food intake and decreased metabolic activity in WAT, predisposing to obesity in adulthood.
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Affiliation(s)
- Kely de Picoli Souza
- School of Environmental and Biological Science, Universidade Federal da Grande Dourados Dourados, Brazil
| | - Elton D da Silva
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Elice C Batista
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Felipe C G Reis
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Sylvia M A Silva
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Charlles H M Castro
- Department of Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Jaqueline Luz
- Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Jorge L Pesquero
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Edson L Dos Santos
- School of Environmental and Biological Science, Universidade Federal da Grande Dourados Dourados, Brazil
| | - João B Pesquero
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
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