Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis

ABSTRACT

Objective

Reducing maternal morbidity and mortality has been a challenge for low and middle-income countries, especially in the setting of hypertensive disorders of pregnancy. Improved strategies for treating obstetric patients with resistant hypertension are needed. We sought to explore whether hemodynamic parameters may be used to identify patients that develop resistant hypertension in pregnancy.

Methods

Retrospective cohort study among pregnant patients with gestational hypertension or preeclampsia that experienced severe blood pressure elevations. Hemodynamic variables were evaluated, including cardiac output (CO), and total peripheral resistance (TPR). The primary endpoint was resistant hypertension. An exploratory logistic regression was performed to evaluate the association between the hemodynamic profile and the development of resistant hypertension. Adverse maternal and fetal outcomes were additionally described according to the presence of resistant hypertension.

Results

Fifty-seven patients with severe pregnancy hypertension were included, of whom 34 developed resistant hypertension (59.7%). The resistant hypertension group, in comparison to those without resistant hypertension, presented with a hypodynamic profile characterized by reduced CO < 5 L/min (41.2% vs. 8.7%, p: 0.007), and increased TPR > 1400 dyn-s/cm5 (64.7% vs. 39.1%, p: 0.057). Logistic regression analysis revealed an association between a hypodynamic profile and resistant hypertension (OR 3.252, 95% CI 1.079–9.804; p = 0.035). Newborns of the resistant hypertension group had more frequent low birth weight (<2500 g), low Apgar scores, ICU admissions, and acute respiratory distress syndrome.

Conclusion

Patients experiencing hypertensive crisis during pregnancy and exhibiting a hypodynamic profile (TPR ≥1400 dyn·s/cm5 and CO ≤ 5 L/min) developed higher rates of resistant hypertension.

KEYWORDS:

• Pregnancy hypertensive disorders
• bioreactance
• hemodynamic parameters
• resistant hypertension
• hypertensive crisis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

María F. Escobar, Javier A. Carvajal, y María P. Echavarría conceived the idea and collaborated in drafting the protocol. María A. Zambrano, Laura Sofia Gutierrez-Puerto, and Felipe Aguilar-Cano drafted the protocol and collected the data. José A. Rojas, Jose A. Santacruz, and Merida Rodriguez analyzed and interpreted the data. Evelyn E. Peña y María A. Zambrano wrote the manuscript. All authors read and approved the final manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author (MFE), upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10641955.2023.2272176

Additional information

Funding

The authors declare that this research has been carried out without any commercial or financial relationship.