(625) Effectiveness of the antihypertensive therapy based on the hemodynamic findings in women with Hypertensive Disorders

To compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy in accordance with the baseline hemodynamic findings


Study Design: Prospective multicenter study including a population of women with a recent diagnosis of Hypertensive Disorder Pregnancy (HDP). A maternal hemodynamic assessment of the following parameters was done by means of a non-invasive tool (USCOM) before any antihypertensive therapy: Cardiac Output (CO), Heart Rate (HR), Systemic Vascular Resistance (SVR), Stroke Volume (SV). The clinician who prescribed the antihypertensive therapy was blinded to the hemodynamic evaluation and based on his preferences or on the local protocols used as 1^st line a vasodilator (nifedipine or metildopa) or a beta-blocker (labetalol). The use of a vasodilatator was retrospectively considered appropriate with a CO <5L/min and/or SVR>1300 dynes*s*cm^-5, while beta blocker was considered appropriate with a CO >8 L/min and/or SVR<900 dynes*s*cm-5. The Primary outcome was to compare the blood pressure values at 24-72 hours between the group with and without hemodynamically appropriate therapy.

Results: A total of 44 women were included with 8(18.2%) of them receiving an inappropriate treatment. Mean SBP >24 hour from the first line therapy and within the next 72h was lower in women receiving an appropriate therapy (130.9±8.3 mmHg vs. 137.7±

5.9 mmHg; p=0.03) compared with those receiving an inappropriate therapy while mean DBP values did not differ between the two groups (81.8±7.2 vs 81.6±7.2 mmHg; p=0.93).

Conclusion:

In women with de novo HDP a better control of the SBP is achieved when the use of the antihypertensive therapy is tailored on maternal hemodynamic profile.