Pharmacological Management of Arterial Hypertension and Clinical Outcome of a Retrospective Cohort of Patients with Eclampsia

Abstract

Background: The best therapeutic measures in patients with eclampsia are termination of pregnancy, administration of anticonvulsant drugs, control of blood pressure with antihypertensive drugs, and critical care to improve outcome. This study aimed to analyze the pharmacological management of arterial hypertension and clinical outcome of a retrospective cohort of patients with eclampsia.
 Methods: This is a retrospective cohort of 37 patients with eclampsia from the intensive care unit (ICU). The files were consulted to know their general data, the characteristics of the seizures and blood pressure. Changes in blood pressure at admission vs. discharge were compared, as well as antihypertensive management and outcome. Descriptive statistics and the Student's t-test with the SPSS version 20 program were used. P=0.05 was significant.
 Results: Mean age 25.86±7.82 years and gestation 33.48±3.97 weeks. Patients with pregnancy 56.76% and puerperium 43.24%. Anticonvulsant drugs was administered in 100% (magnesium sulfate, sodium phenytoin, diazepam). Systolic blood pressure: admission vs discharge 143.08±22.10 vs 125.7±11.26 mmHg (P=0.06) and diastolic blood pressure: admission vs discharge 88.69±14.15 vs 76.6±9.56 mmHg (P=0.76). It was found that 91.89% received antihypertensive drugs and 8.11% none. Indeed, a group of patients with severe preeclampsia convulsed in the ICU 21.63% (n=8/37) when they were already receiving anticonvulsant drugs. In them, pre-seizure blood pressure increased compared to admission pressure (systolic 13.53%, P=0.05, diastolic 22.46%, P=0.05), one patient did not have antihypertensive management and seven patients received only oral antihypertensive drugs. ICU stay was similar to that of the group (P=0.20). Mortality was 0%.
 Conclusion: The evolution of the patients was not satisfactory, but without maternal deaths. Eight new cases of eclampsia occurred in the ICU with uncontrolled hypertension, probably due to insufficient pharmacological management. The data suggest not discontinuing antihypertensive agents despite blood pressure remaining controlled. Deviations from the handling guidelines should be avoided.