Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis
ABSTRACTObjective Reducing maternal morbidity and mortality has been a challenge for low and middle-income countries, especially in the setting of hypertensive disorders of pregnancy. Improved strategies for treating obstetric patients with resistant hypertension are needed. We sought to explore whe...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Hypertension in Pregnancy |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/10641955.2023.2272176 |
| _version_ | 1827593374609178624 |
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| author | María Andrea Zambrano Jose A. Rojas-Suarez Evelyn E. Peña-Zarate Javier Andres Carvajal Laura Sofia Gutierrez-Puerto Felipe Aguilar-Cano Jose Santacruz-Arias Merida Rodríguez-Lopez María Fernanda Escobar |
| author_facet | María Andrea Zambrano Jose A. Rojas-Suarez Evelyn E. Peña-Zarate Javier Andres Carvajal Laura Sofia Gutierrez-Puerto Felipe Aguilar-Cano Jose Santacruz-Arias Merida Rodríguez-Lopez María Fernanda Escobar |
| author_sort | María Andrea Zambrano |
| collection | DOAJ |
| description | ABSTRACTObjective Reducing maternal morbidity and mortality has been a challenge for low and middle-income countries, especially in the setting of hypertensive disorders of pregnancy. Improved strategies for treating obstetric patients with resistant hypertension are needed. We sought to explore whether hemodynamic parameters may be used to identify patients that develop resistant hypertension in pregnancy.Methods Retrospective cohort study among pregnant patients with gestational hypertension or preeclampsia that experienced severe blood pressure elevations. Hemodynamic variables were evaluated, including cardiac output (CO), and total peripheral resistance (TPR). The primary endpoint was resistant hypertension. An exploratory logistic regression was performed to evaluate the association between the hemodynamic profile and the development of resistant hypertension. Adverse maternal and fetal outcomes were additionally described according to the presence of resistant hypertension.Results Fifty-seven patients with severe pregnancy hypertension were included, of whom 34 developed resistant hypertension (59.7%). The resistant hypertension group, in comparison to those without resistant hypertension, presented with a hypodynamic profile characterized by reduced CO < 5 L/min (41.2% vs. 8.7%, p: 0.007), and increased TPR > 1400 dyn-s/cm5 (64.7% vs. 39.1%, p: 0.057). Logistic regression analysis revealed an association between a hypodynamic profile and resistant hypertension (OR 3.252, 95% CI 1.079–9.804; p = 0.035). Newborns of the resistant hypertension group had more frequent low birth weight (<2500 g), low Apgar scores, ICU admissions, and acute respiratory distress syndrome.Conclusion Patients experiencing hypertensive crisis during pregnancy and exhibiting a hypodynamic profile (TPR ≥1400 dyn·s/cm5 and CO ≤ 5 L/min) developed higher rates of resistant hypertension. |
| first_indexed | 2024-03-09T02:09:37Z |
| format | Article |
| id | doaj.art-4213d6d99dd44eeaae6b343c95e636c1 |
| institution | Directory Open Access Journal |
| issn | 1064-1955 1525-6065 |
| language | English |
| last_indexed | 2024-03-09T02:09:37Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Hypertension in Pregnancy |
| spelling | doaj.art-4213d6d99dd44eeaae6b343c95e636c12023-12-07T14:59:28ZengTaylor & Francis GroupHypertension in Pregnancy1064-19551525-60652023-12-0142110.1080/10641955.2023.2272176Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisisMaría Andrea Zambrano0Jose A. Rojas-Suarez1Evelyn E. Peña-Zarate2Javier Andres Carvajal3Laura Sofia Gutierrez-Puerto4Felipe Aguilar-Cano5Jose Santacruz-Arias6Merida Rodríguez-Lopez7María Fernanda Escobar8Facultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaIntensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, ColombiaCentro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaIntensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Cartagena, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaABSTRACTObjective Reducing maternal morbidity and mortality has been a challenge for low and middle-income countries, especially in the setting of hypertensive disorders of pregnancy. Improved strategies for treating obstetric patients with resistant hypertension are needed. We sought to explore whether hemodynamic parameters may be used to identify patients that develop resistant hypertension in pregnancy.Methods Retrospective cohort study among pregnant patients with gestational hypertension or preeclampsia that experienced severe blood pressure elevations. Hemodynamic variables were evaluated, including cardiac output (CO), and total peripheral resistance (TPR). The primary endpoint was resistant hypertension. An exploratory logistic regression was performed to evaluate the association between the hemodynamic profile and the development of resistant hypertension. Adverse maternal and fetal outcomes were additionally described according to the presence of resistant hypertension.Results Fifty-seven patients with severe pregnancy hypertension were included, of whom 34 developed resistant hypertension (59.7%). The resistant hypertension group, in comparison to those without resistant hypertension, presented with a hypodynamic profile characterized by reduced CO < 5 L/min (41.2% vs. 8.7%, p: 0.007), and increased TPR > 1400 dyn-s/cm5 (64.7% vs. 39.1%, p: 0.057). Logistic regression analysis revealed an association between a hypodynamic profile and resistant hypertension (OR 3.252, 95% CI 1.079–9.804; p = 0.035). Newborns of the resistant hypertension group had more frequent low birth weight (<2500 g), low Apgar scores, ICU admissions, and acute respiratory distress syndrome.Conclusion Patients experiencing hypertensive crisis during pregnancy and exhibiting a hypodynamic profile (TPR ≥1400 dyn·s/cm5 and CO ≤ 5 L/min) developed higher rates of resistant hypertension.https://www.tandfonline.com/doi/10.1080/10641955.2023.2272176Pregnancy hypertensive disordersbioreactancehemodynamic parametersresistant hypertensionhypertensive crisis |
| spellingShingle | María Andrea Zambrano Jose A. Rojas-Suarez Evelyn E. Peña-Zarate Javier Andres Carvajal Laura Sofia Gutierrez-Puerto Felipe Aguilar-Cano Jose Santacruz-Arias Merida Rodríguez-Lopez María Fernanda Escobar Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis Hypertension in Pregnancy Pregnancy hypertensive disorders bioreactance hemodynamic parameters resistant hypertension hypertensive crisis |
| title | Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis |
| title_full | Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis |
| title_fullStr | Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis |
| title_full_unstemmed | Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis |
| title_short | Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis |
| title_sort | relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis |
| topic | Pregnancy hypertensive disorders bioreactance hemodynamic parameters resistant hypertension hypertensive crisis |
| url | https://www.tandfonline.com/doi/10.1080/10641955.2023.2272176 |
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