TREATMENT OF HYPERTENSION IN PREGNANCY: A SINGLE-CENTER 4-YEAR RETROSPECTIVE STUDY

Aims: To evaluate the treatment in women with hypertension in pregnancy and the relationship between studied parameters (age, diabetes mellitus (DM), quantitative proteinuria, serum uric acid) and the treatment.
Patients and methods: 308 pregnant women, aged 32 (28-35; median, IQR) years, 16% with DM, admitted to the St. Cyril and Methodius Hospital due to hypertension in pregnancy (4% with purely pre-existing hypertension) from June 2011 to June 2015 were included. The treatment was evaluated until the day of delivery. In case of repeated measurements of proteinuria and uric acid, the highest ante-partum value was used.
Results: Most women - 38% - were treated with 2 antihypertensive drugs, 32% patients with 1 drug, 23% with 3 drugs, 6 % with 4 drugs and only 1 patient with 5 drugs. The most frequent antihypertensive drugs were: methyldopa (97%), isradipine (50%), intravenous (i.v.) urapidil (27%), oral urapidil (18%), metoprolol (8%), amlodipine (7%), verapamil (4%). There was only sporadic use of other antihypertensive drugs.
The number of drugs needed to control hypertension was increasing with growing age (p<0.05) and increasing proteinuria (p<0.001). There was no relationship between DM or serum uric acid and the number of drugs needed.
Treatment was consistent with current ESH/ESC guidelines, except for urapidil. Urapidil was predominantly used intravenously, as the by guidelines recommended i.v. drugs for treatment of hypertension in pregnancy (labetalol, sodium nitroprusside, nitroglycerin) are not available in Slovakia.
Conclusions: The number of drugs needed to control hypertension in pregnancy showed a correlation with increasing quantitative proteinuria and age. Most patients were concomitantly treated with 2 antihypertensive drugs. Methyldopa, isradipine and urapidil were the most frequently used drugs.