Gestasyonel hipertansiyon ve güncel tedavi yaklaşımları

Yıl 2022, Cilt: 3 Sayı: 2, 122 - 127, 28.06.2022

Hafize Tuğba Karahan , Erdem Karahan , Alpaslan Tanoğlu

https://doi.org/10.47582/jompac.1133523

Öz

Gebelikte optimal kan basıncının idame edilmesi sağlıklı fetüs gelişimi için vazgeçilmez bir unsurdur. Gebeliğin 20. haftasından sonra proteinüri benzeri sistemik bulguların eşlik etmediği, kan basıncının 140/90 mmHg ve üzerinde olmasına ‘gestasyonel hipertansiyon’ denir. Hamilelik sırasındaki hipertansif bozukluklar, uzun vadede kardiyovasküler hastalık riskini attırdığı için bu hastalara ömür boyu takip önerilmelidir. Anne ölümlerine ilişkin araştırmalar preeklampsi ve eklampsiye bu konuda göz ardı edilmemesi gereken nedenler olduğunu ortaya koymuştur. Gebelik döneminde tedavi edilmeyen hipertansiyon hem anne hem de bebek için maternal kardiyovasküler çeşitli morbiditelere yol açabilir. İlave olarak gebelik sonrası yaşamda kardiyovasküler hastalıklar da gestasyonel hipertansiyon tanısı konulmuş annelerde daha sık görülür. Bu derlemede gestasyonel hipertansiyon ve yeni tedavi yaklaşımları ele alınmıştır.

Anahtar Kelimeler

Gestasyonel hipertansiyon, gebelikte hipertansiyon, preeklampsi, gebelikte antihipertansifler

Gestational hypertension and current treatment approaches

Öz

Maintaining optimal blood pressure during pregnancy is an essential element for healthy fetal development. Gestational hypertension is defined as a blood pressure of 140/90 mmHg and above without accompanying systemic findings such as proteinuria after the 20th week of pregnancy. Because hypertensive disorders during pregnancy increase the long-term risk of cardiovascular disease, these patients should be offered lifelong follow-up. Studies on maternal deaths have revealed that preeclampsia and eclampsia are causes that should not be ignored in this regard. Untreated hypertension during pregnancy can lead to various maternal cardiovascular morbidities for both mother and baby. In addition, cardiovascular diseases are more common in mothers diagnosed with gestational hypertension in the post-pregnancy life. In this review, gestational hypertension and new treatment approaches are discussed.

Anahtar Kelimeler

Gestational hypertension, hypertension in pregnancy, preeclampsia, antihypertensives in pregnancy

Kaynakça

• Gyselaers W. Hemodynamic pathways of gestational hypertension and preeclampsia. Am J Obstet Gynecol 2022; 226: 988-1005.
• Hauspurg A, Jeyabalan A. Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022; 226: 1211-21.
• Goddard J, Wee MYK, Vinayakarao L. Update on hypertensive disorders in pregnancy. BJA Educ 2020; 20: 411-6.
• Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP clas-sification, diagnosis, and management recommendations for international practice. Hyper-tension 2018; 72: 24-43.
• NICE. Hypertension in pregnancy: diagnosis and management. Natl Inst Heal Care Excell 2019; 77: S1e22.
• ACOG. ACOG practice bulletin no 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019; 133: 1-25.
• Brown MA, Magee LA, Kenny LC, et al; International Society for the Study of Hypertension in Pregnancy (ISSHP). The hypertensive disorders of pregnancy: ISSHP classification, diag-nosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13: 291-10.
• Erez O, Romero R, Jung E, et al. Pre-eclampsia and eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol 2022; 226: 786-803.
• Bartsch E, Medcalf KE, Park AL, et al. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016; 353: i1753.
• Sunjaya AF, Sunjaya AP. Evaluation of serum biomarkers and other diagnostic modalities for early diagnosis of preeclampsia. J Family Reprod Health 2019; 13: 56-69.
• Chappell LC, Duckworth S, Seed PT, et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation 2013; 128: 2121-31.
• MacDonald TM, Walker SP, Hannan NJ, Tong S, Kaitu’u-Lino TJ. Clinical tools and biomar-kers to predict preeclampsia. EBioMedicine 2022; 75: 103780.
• PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys im-munoassay sFlt-1/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryp-tor/BRAHMS PlGF plus Kryptor PE ratio) NICE Diagn Guide 2016: 1-46. www.nice.org.uk/guidance/dg23
• Demir ME, Ulas T, Dal MS, et al. Oxidative stress parameters and ceruloplasmin levels in pati-ents with severe preeclampsia. Clin Ter 2013; 164: e83-7
• Artunc-Ulkumen B, Guvenc Y, Goker A, Gozukara C. Relationship of neutrophil gelatinase-associated lipocalin (NGAL) and procalcitonin levels with the presence and severity of the preeclampsia. J Matern Fetal Neonatal Med 2015; 28: 1895-900.
• Von Dadelszen P, Menzies JM, Payne B, Magee LA; PIERS (Pre-eclampsia Integrated Esti-mate of RiSk) Study Group. Predicting adverse outcomes in women with severe pre-eclampsia. Semin Perinatol 2009; 33: 152-7.
• Edgar V. Lerma, Mitchell H. Rosner, Mark A. Perazella. Current Nefroloji ve Hipertansiyon Tanı ve Tedavi 2019, Güneş Tıp Kitabevi, Ankara.
• Danielli M, Gillies C, Thomas RC, et al. Effects of supervised exercise on the development of hypertensive disorders of pregnancy: a systematic review and meta-analysis. J Clin Med 2022; 11: 793.
• Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377: 613-22.
• Fogacci S, Fogacci F, Cicero AFG. Nutraceuticals and hypertensive disorders in pregnancy: the available clinical evidence. Nutrients 2020; 31; 12: 378.
• Wen SW, White RR, Rybak N, et al. Effect of high dose folic acid supplementation in preg-nancy on preeclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial. BMJ 2018; 362: 1-8.
• Liu S, Chan WS, Ray JG, et al. Stroke and cerebrovascular disease in pregnancy: incidence, temporal trends, and risk factors. Stroke 2019; 50: 13-20.
• Beech A, Mangos G. Management of hypertension in pregnancy. Aust Prescr 2021; 44: 148-152.
• Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002; 21: 85.
• Boutroy MJ, Bianchetti G, Dubruc C, et al. To nurse when receiving acebutolol: is it dange-rous for the neonate? Eur J Clin Pharmacol 1986; 30: 737.
• Drugs and Lactation Database (LactMed) http://toxnet.nlm.nih.gov/ (Accessed on July 02, 2014).
• American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No 203: Chronic Hypertension in Pregnancy. Obstet Gynecol 2019; 133: e26.
• Cífková 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. Eur Heart J Cardiovasc Pharmacother 2020; 6: 384-93.
• Magee LA, Namouz-Haddad S, Cao V, Koren G, von Dadelszen P. Labetalol for hyperten-sion in pregnancy. Expert Opin Drug Saf 2015; 14: 453-61.
• Watson K, Broscious R, Devabhakthuni S, Noel ZR. Focused update on pharmacologic ma-nagement of hypertensive emergencies. Curr Hypertens Rep 2018; 20: 56.
• Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D, Daskalakis G. Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis. Am J Obstet Gynecol 2020; 223: 525-37.
• Johal T, Lees CC, Everett TR, Wilkinson IB. The nitric oxide pathway and possible thera-peutic options in pre-eclampsia. Br J Clin Pharmacol 2014; 78: 244-57.
• Brown MA, Wang J, Whitworth JA. The renin-angiotensin-aldosterone system in pre-eclampsia. Clin Exp Hypertens 1997; 19: 713-26.
• Walker JJ. Severe pre-eclampsia and eclampsia. Baillieres Best Pract Res Clin Obstet Gyna-ecol 2000; 14: 57-71.
• Dennis AT. Management of pre-eclampsia: issues for anaesthetists. Anaesthesia 2012; 67: 1009-20.
• Padda J, Khalid K, Colaco LB, et al. Efficacy of magnesium sulfate on maternal mortality in eclampsia. Cureus 2021; 20: e17322.
• Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor E. An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth 2013; 5; 13: 34.
• Russell R. Preeclampsia and the anaesthesiologist: current management. Curr Opin Anaest-hesiol 2020; 33: 305-10.
• Gogarten W. Preeclampsia and anaesthesia. Curr Opin Anaesthesiol 2009; 22: 347-51.
• Lee LO, Bateman BT, Kheterpal S, et al. Risk of epidural hematoma after neuraxial tech-niques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group. Anesthesiology 2017; 126: 1053-64.
• Wasem S, Rifai M, Hönig A, Wirbelauer J, Roewer N, Kranke P. Leser fragen - Experten antworten - Rapid-Sequence-Induction bei Sectio caesarea: Sollte standardmäßig ein Opioid gegeben werden? [Should opioids be routinely used for the induction of general anaesthesia for caesarean section?]. Anasthesiol Intensivmed Notfallmed Schmerzther 2013; 48: 374-7. German.
• Van De Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-based narrative review. Int J Obstet Anesth 2016; 25: 66-74.
• Rasooli S, Moslemi F, Ari R, Shenas HV, Shokoohi M. Comparison of hemodynamic chan-ges due to endotracheal intubation with labetalol and remifentanil in severe preeclamptic pa-tients undergoing cesarean delivery with general anesthesia. Int J Women’s Heal Reprod Sci 2019; 7: 515-9.
• Van Dyk D, Dyer RA, Fernandes NL. Preeclampsia in 2021-a Perioperative medical challen-ge for the anesthesiologist. Anesthesiol Clin 2021; 39: 711-25.
• Benschop L, Duvekot JJ, Roeters van Lennep JE. Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy. Heart 2019; 105: 1273-8.
• Groenhof TKJ, van Rijn BB, Franx A, Roeters van Lennep JE, Bots ML, Lely AT. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when. Eur J Prev Cardiol 2017; 24: 1735-45.