Treatment of arterial hypertension in pregnant women

Abstract

Arterial hypertension (AH) syndrome can occur with the development of pregnancy as a previous pathology, or be a clinical symptom of nephropathy in pregnant women. AH of any origin is a risk factor for the development of nephropathy (preeclampsia/eclampsia). It causes complications of pregnancy itself (placental abruption, premature birth, cerebrovascular disorders, the deve­lopment of disseminated intravascular coagulation, multiple organ failure), significantly increases the risk of both morbidity and mortality for a mother, fetus and newborn. Hypertension may result in a more difficult course of pregnancy and may complicate subsequent pregnancies. AH increases the risk of intrauterine growth retardation and fetal death. When selecting a tactical solution or choosing an antihypertensive therapy, it is necessary to take into account the negative impact of certain groups of antihypertensive drugs on the general hemodynamics in a pregnant woman, on the placental circulation, fetal growth restriction, and developmental defects. This is why no definitive recommendation can yet be made. The database of drugs aimed at treating AH-related pregnancy complications contains insufficient evidence with regard to the drug impact on fetal development. This article provides a brief overview of modern approaches to the treatment of hypertension in pregnant women with non-vasodilatory and vasodilatory selective beta-blockers. From the perspective of a nephrologist, according to the results of the studies, the prescription of selective beta-blockers in the II–III trimester of pregnancy does not pose a threat to either mother or fetus. In the first trimester, most researchers consider nebivolol, a vasodilatory selective beta-blocker, to be the safest and most effective choice. Nonetheless, the studies carried out so far do not provide sufficient evidence to recommend nebivolol for prescription in the first trimester of pregnancy.