Abstract

Background. Complications in early onset mild gestational hypertension (GH) are predicted by Total Peripheral Vascular Resistance (TPVR)>1350 dyne more than by blood pressure levels. We therefore assessed the possible reduction of severe complications lowering TPVR with NO donors, oral fluids and standard antihypertensive therapy in women with early onset mild GH. Methods. A group of 400 patients with early onset (20-27 weeks gestation) mild GH (systolic and diastolic BP<170/110 mmHg) and TPVR>1350 dyne were enrolled in a case-control study: 100 patients were treated with nifedipine (group A); 100 with nifedipine and NO donors (group B); 100 with nifedipine, and oral fluids (Group C); 100 with nifedipine, NO donors and oral fluids (Group D). TPVR was checked 1 month after initiation of therapy noting the percentage of patients with severe maternal and fetal complications in each group. The relationship between TPVR reduction and the rate of severe complications was assessed. Results. Severe complications developed in 51% of patents in group A, 48% in group B; 53% in group C, and 35% in group D (Groups A vs. group D, p<0.001, group B vs. group D, p<0.001; group C vs. group D, p<0.001); they developed when TPVR reduced <15%; in group D the reduction ≥ 15% was more probable (OR 2.03, CI 1.15-3.60, P<0.015), and severe complications less probable (OR 0.52, CI 0.29-0.91, P<0.023). Conclusions. In women with early-onset mild GH combined treatment with NO donors, oral fluids and nifedipine optimally reduces TPVR and seems to reduce maternal and fetal complications. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.