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antihypertensive and pregnancy

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https://www.readbyqxmd.com/read/28333820/committee-opinion-no-692-emergent-therapy-for-acute-onset-severe-hypertension-during-pregnancy-and-the-postpartum-period
#1
(no author information available yet)
Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28333812/committee-opinion-no-692-summary-emergent-therapy-for-acute-onset-severe-hypertension-during-pregnancy-and-the-postpartum-period
#2
(no author information available yet)
Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28280642/severe-preeclampsia-in-the-setting-of-myasthenia-gravis
#3
Adam J Lake, Antoun Al Khabbaz, Renée Keeney
Myasthenia gravis (MG) is a rare autoimmune disease that leads to progressive muscle weakness and is common during female reproductive years. The myasthenic mother and her newborn must be observed carefully, as complications during all stages of pregnancy and the puerperium may arise suddenly. Preeclampsia is a common obstetrical condition for which magnesium sulfate is used for seizure prophylaxis. However, magnesium sulfate is strongly contraindicated in MG as it impairs already slowed nerve-muscle connections...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28279445/a-comprehensive-analysis-of-continuous-epidural-analgesia-s-effect-on-labor-and-neonates-in-maternal-hypertensive-disorder-patients
#4
Bin Han, Mingjun Xu
BACKGROUND: Maternal hypertensive disorder is one of the most common and severe medical complications during pregnancy. Epidural analgesia administration is widely used during labor process. AIM: To evaluate the potential advantage or disadvantage of continuous epidural analgesia's on labor and neonates for maternal hypertensive disorder patients comprehensively. METHODS: We have retrospectively analyzed 232 patients who diagnosed as maternal hypertensive disorder in our hospital since 2015...
January 2017: Pregnancy Hypertension
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#5
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28153655/early-standardized-treatment-of-critical-blood-pressure-elevations-is-associated-with-a-reduction-in-eclampsia-and%C3%A2-severe-maternal-morbidity
#6
Laurence E Shields, Suzanne Wiesner, Catherine Klein, Barbara Pelletreau, Herman L Hedriana
BACKGROUND: Hypertensive disorders of pregnancy result in significant maternal morbidity and mortality. State and national guidelines have been proposed to increase treatment of patients with hypertensive emergencies or critically elevated blood pressures. There are limited data available to assess the impact of these recommendations on maternal morbidity. OBJECTIVE: The purpose of this prospective quality improvement project was to determine if maternal morbidity would be improved using a standardized approach for treatment of critically elevated blood pressures...
January 30, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28137991/association-of-pregnancy-complications-and-characteristics-with-future-risk-of-elevated-blood-pressure-the-v%C3%A3-sterbotten-intervention-program
#7
Nisha I Parikh, Margareta Norberg, Erik Ingelsson, Sven Cnattingius, Ramachandran S Vasan, Magnus Domellöf, Jan Håkan Jansson, Anna-Karin Edstedt Bonamy
Pregnancy characteristics are associated with risk of cardiovascular diseases, but their independent associations with hypertension or blood pressure (BP) levels remain uncertain. We linked the Swedish Medical Birth Register with Västerbotten Intervention Program data (Northern Sweden). Using linear and logistic regression, we related pregnancy factors in any prior pregnancy with BP and hypertension at 40 years of age in 15 896 parous women free of prepregnancy hypertension. Pregnancy factors included parity, age at first delivery, preeclampsia, gestational diabetes mellitus, placental abruption, shortest gestational age small for gestational age baby (<third percentile for birth weight) or stillbirth...
March 2017: Hypertension
https://www.readbyqxmd.com/read/28125624/clonidine-versus-captopril-for-severe-postpartum-hypertension-a-randomized-controlled-trial
#8
Carlos Noronha Neto C, Sabina S B Maia, Leila Katz, Isabela C Coutinho, Alex R Souza, Melania M Amorim
BACKGROUND: Changes during the puerperium are still unclear, particularly in women with hypertension. The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, also requires further elucidation. Currently, there are no clear data to guide the decision for the choice of postpartum antihypertensives. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effect...
2017: PloS One
https://www.readbyqxmd.com/read/28120288/missed-opportunities-to-improve-the-health-of-postpartum-women-high-rates-of-untreated-hypertension-in-rural-tanzania
#9
Elysia Larson, Miriam Rabkin, Godfrey M Mbaruku, Redempta Mbatia, Margaret E Kruk
Objectives To assess the prevalence of high blood pressure amongst postpartum women in rural Tanzania, and to explore factors associated with hypertension prevalence, awareness, treatment, and control. Methods 1849 women in Tanzania's Pwani Region who delivered a child in the prior year participated in the study. We measured blood pressure, administered a structured questionnaire and assessed factors associated with the prevalence, awareness, treatment, and control of hypertension (HTN) using bivariable and multivariable logistic regressions...
March 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28079872/is-use-of-multiple-antihypertensive-agents-to-achieve-blood-pressure-control-associated-with-adverse-pregnancy-outcomes
#10
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
#11
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
#12
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...
March 2017: 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
#13
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
#14
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
#15
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
#16
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-hemodynamic-monitoring-to-guide-treatment-of-maternal-hypertension-leads-to-reduction-in-severe-hypertension
#17
D Stott, I Papastefanou, D Paraschiv, K Clark, N A Kametas
OBJECTIVES: To examine whether treatment for hypertension in pregnancy that is guided by serial monitoring of maternal central hemodynamics leads to a reduction in the rate of severe hypertension, defined as blood pressure ≥ 160/110 mmHg; and to assess the distinct longitudinal hemodynamic profiles associated with beta-blocker monotherapy, vasodilator monotherapy and dual agent therapy, and their relationships with outcomes, including fetal growth restriction. METHODS: This was a prospective observational study at a dedicated antenatal hypertension clinic in a tertiary UK hospital...
January 2017: 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
#18
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
#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/27753900/os-01-09-markers-of-early-renal-impairment-in-prehypertension
#20
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
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