Pharmacological management of hypertension in pregnancy

Easterling, Thomas R.

doi:10.1053/j.semperi.2014.08.016

Cited by 38 publications

(28 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of the complications associated with severe hypertensive disorders in pregnancy includes placental abruption, kidney injury, liver injury, cerebral hemorrhage, seizures, fetal growth restriction, preterm birth, and in some cases maternal or fetal demise . Treatment initiation criteria and hypertension management approaches vary . Among other drugs, hydralazine is one of the antihypertensive drugs recommended by the American College of Obstetricians and Gynecologists for pregnant women because of its efficacy in lowering total peripheral resistance (TPR) and relative safety for the mother and fetus…”

mentioning

confidence: 99%

Effect of N‐Acetyltransferase 2 Genotype on the Pharmacokinetics of Hydralazine During Pregnancy

Han

Ryu

Cusumano

et al. 2019

The Journal of Clinical Pharma

Self Cite

View full text Add to dashboard Cite

Hydralazine, an antihypertensive agent used during pregnancy, undergoes N‐acetylation primarily via N‐acetyltransferase 2 (NAT2) to form 3‐methyl‐1,2,4‐triazolo[3,4‐a]phthalazine (MTP). To characterize the steady‐state pharmacokinetics (PK) of hydralazine during pregnancy and evaluate the effects of NAT2 genotype on hydralazine and MTP PK during pregnancy, 12 pregnant subjects received oral hydralazine (5‐25 mg every 6 hours) in mid‐ (n = 5) and/or late pregnancy (n = 8). Serial blood samples were collected over 1 dosing interval, and steady‐state noncompartmental PK parameters were estimated. Subjects were classified as either (rapid acetylators, n = 6) or slow acetylators (SAs, n = 6) based on NAT2 genotype. During pregnancy, when compared with the SA group, the RA group had faster weight‐adjusted hydralazine apparent oral clearance (70.0 ± 13.6 vs 20.1 ± 6.9 L/h, P < .05), lower dose‐normalized area under the concentration‐time curve (AUC; 1.5 ± 0.8 vs 5.9 ± 3.7 ng·h/mL, P < .05), lower dose‐normalized peak concentrations (0.77 ± 0.51 vs 4.04 ± 3.18 ng/mL, P < .05), and larger weight‐adjusted apparent oral volume of distribution (302 ± 112 vs 116 ± 45 L/kg, P < .05). Furthermore, the MTP/hydralazine AUC ratio was ∼10‐fold higher in the RA group (78 ± 30 vs 8 ± 3, P < .05) than in the SA group. No gestational age or dose‐dependent effects were observed, possibly because of the small sample size. This study describes for the first time, the PK of oral hydralazine and its metabolite, MTP, during pregnancy, and confirmed that the PK of oral hydralazine is NAT2 genotype dependent during pregnancy.

show abstract

mentioning

confidence: 99%

Effect of N‐Acetyltransferase 2 Genotype on the Pharmacokinetics of Hydralazine During Pregnancy

Han

Ryu

Cusumano

et al. 2019

The Journal of Clinical Pharma

Self Cite

View full text Add to dashboard Cite

show abstract

“…Clinically, the increased apparent oral clearance of clonidine in pregnancy suggests a benefit to shorter dosing frequency than twice a day commonly used outside pregnancy. Dosing every 8 hours seems to provide continuous coverage …”

Section: Safety Of Medication Used For Postural Tachycardia Syndrome mentioning

confidence: 99%

Postural tachycardia syndrome and pregnancy

Bhatia

Kavi

Nelson‐Piercy

2018

The Obstetric & Gynaecologis

View full text Add to dashboard Cite

Key content Postural tachycardia syndrome (PoTS) is a potentially debilitating autonomic disturbance that primarily affects females between the ages of 15 and 50 years, and may present for the first time during pregnancy. The typical signs and symptoms are vague and therefore the condition is often under‐ or misdiagnosed as pregnancy may induce similar symptoms. If correctly diagnosed and managed, patients have a good outcome; however, a delay in diagnosis may be disabling. PoTS is unfamiliar to most clinicians and its variable course during pregnancy requires a better understanding of the condition. PoTS management in pregnancy may be challenging and clinicians should be aware of common strategies that are suitable in pregnancy. A multidisciplinary approach is essential for correctly diagnosing and managing the condition and optimising pregnancy outcomes. Learning objectives To understand: The common symptoms and signs of PoTS. How to diagnose and manage PoTS safely in pregnancy. The likely course of disease in pregnant women with PoTS. The effect of pregnancy on PoTS. Multidisciplinary antenatal, intrapartum and postnatal considerations required for patients with PoTS. Ethical issues The impact of delayed diagnosis on individuals. The safety of commonly used pharmaceutical agents. The role of psychological support.

show abstract

“…For the fetus, there are risks of preterm birth, intrauterine growth restriction, and stillbirth. Based on these risks, treatment of severe hypertension is paramount . However, treatment of mild to moderate hypertension remains controversial due to a lack of evidence demonstrating that blood pressure reductions improve maternal and fetal complications .…”

Section: Pharmacotherapy Approach In Specific Female Patient Populationsmentioning

confidence: 99%

Antihypertensive Therapy in Females: A Clinical Review Across the Lifespan

Marrs

Thompson

2016

Pharmacotherapy

View full text Add to dashboard Cite

Hypertension affects one-third of all females in the United States, with the prevalence increasing over a female's lifespan. The approach to treating females with hypertension varies depending on a female's age, race, comorbidities, and whether she is of child-bearing age or pregnant. It is important to factor in the safety and effectiveness of antihypertensive medications across these populations of females. Blood pressure target goals are the same in females as in males regardless of comorbidities or stage of life, with the exception of those females who are pregnant. Recommendations for antihypertensive medication do not differ between females and males based on disease state or stage of life, with the exception of females who are pregnant, breastfeeding, or of child-bearing age. Multiple guidelines recommend avoiding renin-angiotensin system blockers during pregnancy and suggest balancing the risk versus benefit in females of child-bearing age. Further, multiple guidelines provide race-based therapy recommendations for the use of calcium channel blockers and thiazide diuretics in black versus nonblack patients, irrespective of sex. Future research is needed to evaluate whether there are sex differences relative to blood pressure and cardiovascular event-lowering relative to specific antihypertensive medications with a focus on pharmacogenomic differences.

show abstract

Pharmacological management of hypertension in pregnancy

Cited by 38 publications

References 27 publications

Effect of N‐Acetyltransferase 2 Genotype on the Pharmacokinetics of Hydralazine During Pregnancy

Effect of N‐Acetyltransferase 2 Genotype on the Pharmacokinetics of Hydralazine During Pregnancy

Postural tachycardia syndrome and pregnancy

Antihypertensive Therapy in Females: A Clinical Review Across the Lifespan

Contact Info

Product

Resources

About