OC19.08: Effectiveness of the antihypertensive therapy based on maternal hemodynamic findings in women with HDP: a multicentre prospective study

To compare the blood pressure control in women receiving appropriate or inappropriate antihypertensive therapy in accordance with the baseline hemodynamic findings. Prospective multicentre study including women with de novo HDP. A non-invasive assessment of the following was done upon the hospital admission by means of USCOM before 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 1st line a vasodilator (nifedipine/alpha-methyldopa) or a beta-blocker (labetalol). The 1st line treatment was retrospectively considered hemodynamically appropriate in either of the following circumstances: 1) hypodynamic profile (low CO [<5L/min] and/or high SVR [>1300 dynes*s*cm]) who were administered oral nifedipine or alpha-methyldopa. 2) hyperdynamic profile (normal or high CO [ >5 L/min] and/or low SVR [<1300 dynes*s*cm-]) who were administered oral labetalol. The primary outcome of the study was to compare the occurrence of severe hypertension between those who were found to be treated with a hemodynamically appropriate or inappropriate therapy. A total of 152 women with HDP were included. Of these the majority displayed a hypodynamic profile (114; 75.0%) and received hemodynamically appropriate treatment (116; 76.3%). The occurrence of severe hypertension prior to delivery was significantly lower in the group with appropriate therapy compared with those inappropriately treated (6.0% vs 19.4%; p = 0.02). Moreover, the number of women who achieved target values of BP within 48-72h from the treatment start was higher in the group who received an appropriate treatment (70.7% vs 50.0%; p = 0.02). In women with de novo HDP a lower occurrence of severe hypertension is observed whether the first line antihypertensive agent turns appropriate in respect of maternal hemodynamic profile.