HOW MANY ANTIHYPERTENSIVE DRUG SHOULD RECEIVE PREGNANT PATIENT WITH HYPERTENSION?

Objective: To determine number of drugs needed to control blood pressure during pregnancy in accordance to pregnancy period.Design and method: The study is a post-hoc analysis of data collected over four years (2015–2019) from 79 pregnant women referred to the clinic with a history of primary hypertension with eclampsia (89.9%) or pre-eclampsia (10.1%) in their previous pregnancy/pregnancies. All included women completed the study. All participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) at approximately 5-week intervals throughout pregnancy. Methyldopa, labetalol, or nifedipine were used in all subjects, with some women also receiving metoprolol transiently. Antihypertensive treatment was administered according to the following protocol: methyldopa as the first-line drug, followed by labetalol, and then nifedipine as needed. The doses of antihypertensive drugs were titrated to achieve and maintain a mean 24-hour systolic/diastolic blood pressure (SBP/DBP) below 130/80 mmHg. In cases of significant discrepancies between ABPM and office blood pressure measurements (OBPM), treatment adjustments were based on ABPM values. Additionally, antihypertensive doses were increased if the maximum OBPM or home blood pressure monitoring (HBPM) values exceeded 160/105 mmHg. Results: The study included 79 pregnant women aged 34 ± 4.7 years. At the beginning of the study, 34.4% of participants did not receive antihypertensive treatment, 39.1% used one antihypertensive drug, and 26.6% required two drugs. According to 24-hour ABPM values, 78% of subjects had well-controlled hypertension at the start of pregnancy. Blood pressure control rates in subsequent measurement periods were as follows: 72%, 83%, 86%, 84%, 85%, 82%, 67% (at the 35th week of pregnancy), and 62% (at the 37th week of pregnancy). The mean number of antihypertensive drugs used during the study is presented in Figure 1. Over the course of pregnancy, more participants required at least one drug, and over 50% needed at least two antihypertensive drugs. By the end of pregnancy, 15% of subjects required three drugs, while 47% needed two antihypertensive drugs. Conclusions: The need for antihypertensive drugs increases during pregnancy and most patients should receive at least two antihypertensive drugs, particularly in later pregnancy.