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antihypertensive and pregnancy

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https://www.readbyqxmd.com/read/28079872/is-use-of-multiple-antihypertensive-agents-to-achieve-blood-pressure-control-associated-with-adverse-pregnancy-outcomes
#1
S E Allen, A Tita, S Anderson, J R Biggio, Dr L M Harper
OBJECTIVE: We assessed whether requiring >1 medication for blood pressure control is associated with adverse pregnancy outcomes. STUDY DESIGN: Retrospective cohort of 974 singletons with chronic hypertension at a tertiary care center. Subjects on >1 antihypertensive agent were compared with those on one agent <20 weeks gestational age with results stratified by average blood pressure (<140/90 and ⩾140/90 mm Hg) from prenatal visits. The primary maternal outcome was preeclampsia; the primary neonatal outcome was small for gestational age (<10th percentile)...
January 12, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28069864/hydralazine-is-involved-in-tele-methylhistamine-metabolism-by-inhibiting-monoamine-oxidase-b-in-pregnancy-associated-hypertensive-mice
#2
Shohei Kawasaki, Koichiro Kako, Yusuke Nagashima, Akihiko Kanou, Junji Ishida, Akiyoshi Fukamizu
Hypertensive disorders of pregnancy globally affect 6-8% of gestation and remain a major cause of both foetal and maternal morbidity and mortality. However, the antihypertensive medications for the patients of this disease are strictly limited due to the teratogenic potentials. Here, we found that tele-methylhistamine (tMH) increased in response to the administration of hydralazine (Hdz), a vasodilative agent, in the pregnancy-associated hypertensive (PAH) mice. Hdz abrogated the degradation of tMH catalyzed by monoamine oxidase B (MAO-B) in vitro These results suggested that Hdz inhibited the MAO-B activity and consequently tMH increased in the maternal circulation of PAH mice...
January 7, 2017: Journal of Biochemistry
https://www.readbyqxmd.com/read/28005594/controversies-regarding-diagnosis-and-treatment-of-severe-hypertension-in-pregnancy
#3
John R Barton, Baha M Sibai
The objective of management of severe hypertension in pregnancy is not for the return of normal blood pressure but rather reduction of blood pressure to a level associated with a decreased risk of end-organ damage including cerebral, cardiac, or renal dysfunction. The parenteral agents labetalol and hydralazine are currently the most widely recommended antihypertensive agents for acute reductions of elevated blood pressure related to preeclampsia. Overcorrection of blood pressure with any antihypertensive agent is possible resulting in reduced uteroplacental blood flow, but is more likely to be encountered in patients <32 weeks' gestation and in those whose fetuses have intrauterine growth retardation...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27998008/antihypertensive-methyldopa-labetalol-hydralazine-and-clonidine-reversed-tnf-%C3%AE-inhibited-enos-expression-in-endothelial-trophoblast-cellular-networks
#4
Bei Xu, Gabriele Bobek, Angela Makris, Annemarie Hennessy
Medications used to control hypertension in pregnancy also improve trophoblast and endothelial cellular interaction in vitro. Tumour necrosis factor-α (TNF-α) inhibits trophoblast and endothelial cellular interactions and simultaneously decreases endothelial nitric oxide synthase (eNOS) expression. This study investigated whether antihypertensive medications improved these cellular interactions by modulating eNOS and inducible nitric oxide synthase (iNOS) expression. Human uterine myometrial microvascular endothelial cells (UtMVECs) were pre-incubated with (or without) low dose TNF-α (0...
December 20, 2016: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/27939462/survey-of-healthcare-professionals-regarding-adjustment-of-antihypertensive-medication-s-in-the-postnatal-period-in-women-with-hypertensive-disorders-of-pregnancy
#5
Alexandra E Cairns, Katherine L Tucker, Paul Leeson, Lucy Mackillop, Richard J McManus
Hypertensive disorders of pregnancy affect approximately one in ten pregnancies and often persist postpartum. Their postnatal course can be unpredictable and complications may occur, hence control remains important but is informed by little evidence. Clinicians from UK primary and secondary healthcare were invited to complete a survey regarding antihypertensive adjustment postpartum. The response rate was 101/390 (26%). Labetalol was the commonest antihypertensive used. Most participants reported following national guidelines when reducing, although not increasing, antihypertensive medications...
October 2016: Pregnancy Hypertension
https://www.readbyqxmd.com/read/27879355/pregnancy-outcomes-in-women-with-diabetes-lessons-learned-from-clinical-research-the-2015-norbert-freinkel-award-lecture
#6
Elisabeth R Mathiesen
Among women with diabetes, the worst pregnancy outcome is seen in the subgroup of women with diabetic nephropathy. Development of severe preeclampsia that leads to early preterm delivery is frequent. Predictors and pathophysiological mechanisms for the development of preeclampsia among women with diabetes and observational studies that support antihypertension treatment for pregnant women with microalbuminuria or diabetic nephropathy preventing preeclampsia and early preterm delivery are presented here. Obtaining and maintaining strict glycemic control before and during pregnancy is paramount to prevent preterm delivery...
December 2016: Diabetes Care
https://www.readbyqxmd.com/read/27821757/nicotinamide-benefits-both-mothers-and-pups-in-two-contrasting-mouse-models-of-preeclampsia
#7
Feng Li, Tomofumi Fushima, Gen Oyanagi, H W Davin Townley-Tilson, Emiko Sato, Hironobu Nakada, Yuji Oe, John R Hagaman, Jennifer Wilder, Manyu Li, Akiyo Sekimoto, Daisuke Saigusa, Hiroshi Sato, Sadayoshi Ito, J Charles Jennette, Nobuyo Maeda, S Ananth Karumanchi, Oliver Smithies, Nobuyuki Takahashi
Preeclampsia (PE) complicates ∼5% of human pregnancies and is one of the leading causes of pregnancy-related maternal deaths. The only definitive treatment, induced delivery, invariably results in prematurity, and in severe early-onset cases may lead to fetal death. Many currently available antihypertensive drugs are teratogenic and therefore precluded from use. Nonteratogenic antihypertensives help control maternal blood pressure in PE, but results in preventing preterm delivery and correcting fetal growth restriction (FGR) that also occurs in PE have been disappointing...
November 22, 2016: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/27800645/serial-haemodynamic-monitoring-to-guide-treatment-of-maternal-hypertension-leads-to-a-reduction-in-severe-hypertension-rates
#8
Daniel Stott, Ioannis Papastefanou, Daniela Paraschiv, Katherine Clark, Nikos A Kametas
OBJECTIVE: Firstly, to examine if treatment for hypertension in pregnancy guided by the serial assessment of maternal central haemodynamics leads to a reduction in the rates of severe hypertension, defined as blood pressure greater than or equal to 160/110mmHg. Secondly, to assess the distinct longitudinal haemodynamic profiles associated with either beta-blocker monotherapy, vasodilator monotherapy, or dual agent therapy, and their relationship with outcomes including fetal growth restriction...
October 31, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27755385/the-antihypertensive-mthfr-gene-polymorphism-rs17367504-g-is-a-possible-novel-protective-locus-for-preeclampsia
#9
Liv Cecilie V Thomsen, Nina S McCarthy, Phillip E Melton, Gemma Cadby, Rigmor Austgulen, Ottar K Nygård, Matthew P Johnson, Shaun Brennecke, Eric K Moses, Line Bjørge, Ann-Charlotte Iversen
OBJECTIVE: Preeclampsia is a complex heterogeneous disease commonly defined by new-onset hypertension and proteinuria in pregnancy. Women experiencing preeclampsia have increased risk for cardiovascular diseases (CVD) later in life. Preeclampsia and CVD share risk factors and pathophysiologic mechanisms, including dysregulated inflammation and raised blood pressure. Despite commonalities, little is known about the contribution of shared genes (pleiotropy) to these diseases. This study aimed to investigate whether genetic risk factors for hypertension or inflammation are pleiotropic by also being associated with preeclampsia...
January 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/27754100/os-21-05-pivotal-role-of-heme-oxygenase-in-amelioration-by-nicotinamide-of-fetal-growth-restriction-associated-with-preeclampsia
#10
Hironobu Nakada, Tomofumi Fushima, Akiyo Sekimoto, Yuji Oe, Emiko Sato, Sadayoshi Ito, Hiroshi Sato, Nobuyuki Takahashi
OBJECTIVE: Preeclampsia (PE) is pregnancy-induced hypertension with proteinuria. It causes maternal death or fetal growth restriction (FGR). Although high BP can be managed with antihypertensive drugs, there is no effective treatment of FGR associated with PE. We have clarified that nicotinamide (Nam) alleviates PE-like condition and FGR induced by soluble fms-like tyrosine kinase-1 (sFlt-1) in mice. But the mechanism of how Nam works is unclear. Because Nam induces cytoprotective heme oxygenase 1 (HO-1), our aim is to clarify whether HO-1 contributes to therapeutic effect of Nam against FGR associated with PE...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753900/os-01-09-markers-of-early-renal-impairment-in-prehypertension
#11
Ana Vrdoljak, Vanja Ivković, Sandra Karanović, Živka Dika, Ivana Vuković, Jelena Kos, Mario Laganović, Tajana Željković Vrkić, Margareta Fištrek Prlić, Ivan Pećin, Bojan Jelaković
OBJECTIVE: It was observed that glomerular hyperfiltration (GHF) is associated with progression of kidney disease in diabetics, patients in stage 1 hypertension (HT), and we found previously that eGFR decreased faster also in prehypertensives (PHT) with GHF. Here we analyzed whether GHF in PHT is associated with other biomarkers of early renal impairment. DESIGN AND METHOD: From 954 subjects enrolled in ENAH follow-up study, 371(137 m;mean age = 46years) were eligible for further analysis:100 with optimal,72 with normal BP,70 with PHT(high normal BP),and 129 with newly diagnosed untreated HT...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27720779/riboflavin-mthfr-genotype-and-blood-pressure-a-personalized-approach-to-prevention-and-treatment-of-hypertension
#12
Helene McNulty, J J Strain, Catherine F Hughes, Mary Ward
Hypertension is the leading risk factor contributing to mortality worldwide, primarily from cardiovascular disease (CVD), while effective treatment of hypertension is proven to reduce CVD events. Along with the well recognized nutrition and lifestyle determinants, genetic factors are implicated in the development and progression of hypertension. In recent years genome-wide association studies have identified a region near the gene encoding the folate-metabolizing enzyme methylenetetrahydrofolate reductase (MTHFR) among eight loci associated with blood pressure...
October 6, 2016: Molecular Aspects of Medicine
https://www.readbyqxmd.com/read/27719683/community-health-worker-knowledge-and-management-of-pre-eclampsia-in-southern-mozambique
#13
Helena Boene, Marianne Vidler, Orvalho Augusto, Mohsin Sidat, Eusébio Macete, Clara Menéndez, Diane Sawchuck, Rahat Qureshi, Peter von Dadelszen, Khátia Munguambe, Esperança Sevene
BACKGROUND: Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990-2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique...
September 30, 2016: Reproductive Health
https://www.readbyqxmd.com/read/27719680/potential-for-task-sharing-to-lady-health-workers-for-identification-and-emergency-management-of-pre-eclampsia-at-community-level-in-pakistan
#14
Rehana A Salam, Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Diane Sawchuck, Marianne Vidler, Peter von Dadelszen, Shujaat Zaidi, Zulfiqar Bhutta
BACKGROUND: An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms...
September 30, 2016: Reproductive Health
https://www.readbyqxmd.com/read/27719678/community-health-worker-knowledge-and-management-of-pre-eclampsia-in-rural-karnataka-state-india
#15
Umesh Ramadurg, Marianne Vidler, Umesh Charanthimath, Geetanjali Katageri, Mrutyunjaya Bellad, Ashalata Mallapur, Shivaprasad Goudar, Shashidhar Bannale, Chandrashekhar Karadiguddi, Diane Sawchuck, Rahat Qureshi, Peter von Dadelszen, Richard Derman
BACKGROUND: In India, the hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40 % of all maternal deaths. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed, and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess...
September 30, 2016: Reproductive Health
https://www.readbyqxmd.com/read/27689239/treatment-options-for-hypertension-in-pregnancy-and-puerperium
#16
Farah H Amro, Hind N Moussa, Olaide A Ashimi, Baha M Sibai
Hypertensive disorders have become increasingly prevalent and complicate an increasing number of pregnancies. Therefore it is essential that the medications used to treat these disorders be well understood. Furthermore the management is complicated by special consideration needed for the physiologic changes of pregnancy as well as the consideration for possible adverse fetal effects. Areas covered: We performed a review of the scientific literature of medications used to treat hypertensive disorders in pregnancy...
December 2016: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/27680821/h5-second-trimester-vascular-function-parameters-in-women-with-chronic-hypertension-and-their-association-with-adverse-maternal-and-perinatal-outcomes
#17
L M Webster, J Fetherston, C Chmiel, C Nelson-Piercy, A Khalil, J Myers, L C Chappell
INTRODUCTION: Increased aortic systolic BP (SBPao), pulse wave velocity (PWVao) and augmentation index of the aorta (AIXao) are associated with increased cardiovascular morbidity. These measures may also be increased prior to the development of adverse maternal and perinatal outcomes. The aim of this study was to evaluate the association between haemodynamic parameters and adverse outcomes in women with chronic hypertension (CHT). METHODS: Women recruited to the PANDA study (Pregnancy And chronic hypertension: NifeDipine versus lAbetalol as antihypertensive treatment) had Arteriograph (Tensio Med) readings taken while sitting...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27643246/os-01-09-markers-of-early-renal-impairment-in-prehypertension
#18
Ana Vrdoljak, Vanja Ivković, Sandra Karanović, Živka Dika, Ivana Vuković, Jelena Kos, Mario Laganović, Tajana Željković Vrkić, Margareta Fištrek Prlić, Ivan Pećin, Bojan Jelaković
OBJECTIVE: It was observed that glomerular hyperfiltration (GHF) is associated with progression of kidney disease in diabetics, patients in stage 1 hypertension (HT), and we found previously that eGFR decreased faster also in prehypertensives (PHT) with GHF. Here we analyzed whether GHF in PHT is associated with other biomarkers of early renal impairment. DESIGN AND METHOD: From 954 subjects enrolled in ENAH follow-up study, 371(137 m;mean age = 46years) were eligible for further analysis:100 with optimal,72 with normal BP,70 with PHT(high normal BP),and 129 with newly diagnosed untreated HT...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643025/os-21-05-pivotal-role-of-heme-oxygenase-in-amelioration-by-nicotinamide-of-fetal-growth-restriction-associated-with-preeclampsia
#19
Hironobu Nakada, Tomofumi Fushima, Akiyo Sekimoto, Yuji Oe, Emiko Sato, Sadayoshi Ito, Hiroshi Sato, Nobuyuki Takahashi
OBJECTIVE: Preeclampsia (PE) is pregnancy-induced hypertension with proteinuria. It causes maternal death or fetal growth restriction (FGR). Although high BP can be managed with antihypertensive drugs, there is no effective treatment of FGR associated with PE. We have clarified that nicotinamide (Nam) alleviates PE-like condition and FGR induced by soluble fms-like tyrosine kinase-1 (sFlt-1) in mice. But the mechanism of how Nam works is unclear. Because Nam induces cytoprotective heme oxygenase 1 (HO-1), our aim is to clarify whether HO-1 contributes to therapeutic effect of Nam against FGR associated with PE...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27620880/sodium-hydrosulfide-prevents-hypertension-and-increases-in-vascular-endothelial-growth-factor-and-soluble-fms-like-tyrosine-kinase-1-in-hypertensive-pregnant-rats
#20
Jose Sergio Possomato-Vieira, Victor Hugo Gonçalves-Rizzi, Tamiris Uracs Sales Graça, Regina Aparecida Nascimento, Carlos A Dias-Junior
Sodium hydrosulfide (NaHS) has presented antihypertensive and antioxidant effects and may reduce circulating soluble fms-like tyrosine kinase-1 (sFlt-1). We examined whether NaHS prevents maternal and fetal detrimental changes in a model of hypertension in pregnancy induced by N(G)-nitro-L-arginine methyl ester (L-NAME). Forty pregnant rats were divided into four groups (n = 10 per group): Norm-Preg, Preg + NaHS, HTN-Preg, or HTN-Preg + NaHS. Systolic blood pressure (SBP), number of viable fetuses, litter size, pups, and placentae weights were recorded...
September 12, 2016: Naunyn-Schmiedeberg's Archives of Pharmacology
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