Resumen
Introducción: los trastornos hipertensivos son la complicación médica más común del embarazo, con una prevalencia mundial de 5 – 10%, y son una causa importante de morbimortalidad, especialmente en países en vía de desarrollo. Existe muy poca información acerca de la evaluación, tratamiento y complicaciones de las pacientes hipertensas durante el puerperio y la falta de guías de manejo de esta patología suele resultar en diagnósticos imprecisos y estrategias de manejo incorrectas. Objetivo: proveer un enfoque acerca de los beneicios y riesgos de los fármacos antihipertensivos en el manejo de la hipertensión posparto. Métodología de búsqueda: se realizó una revisión de la literatura en las bases bibliográicas PubMed, Science Direct, Embase, SciELO y LILACS, limitando la búsqueda a artículos de los últimos 10 años, en español e inglés. Se excluyeron aquellos que no contenían información acerca de la presentación clínica, el tratamiento o las complicaciones de la hipertensión posparto. Resultados: se obtuvo un total de 69 artículos que cumplían los criterios para ser incluidos en esta revisión. Discusión y Conclusiones: debido a la limitación de la literatura acerca del manejo de la hipertensión posparto, no es adecuado hablar de fármacos de primera línea; la elección del mismo es guiada por la etiología subyacente y se deben tener en cuenta factores como la lactancia materna. Los fármacos propuestos pertenecen a los grupos de antagonistas de canales de calcio, β-bloqueadores, bloqueadores del eje renina-angiotensina-aldosterona, diuréticos, α-bloqueadores, entre otros. Se destacan como los más usados: nifedipino, metildopa, y β-bloqueadores como propanolol y labetalol, debido a la evidencia soportando la seguridad de su uso durante el puerperio. MÉD.UIS. 2016;29(2):71-80.
Palabras clave: Hipertensión inducida en el embarazo. Puerperio. Antihipertensivos. Tratamiento.
Referencias
Sibai BM. Etiology and management of postpartum hypertensionpreeclampsia.
Am J Obstet Gynecol. 2012;206(6):470-5.
Qasqas SA, McPherson C, Frishman WH, Elkayam U.
Cardiovascular pharmacotherapeutic considerations during
pregnancy and lactation. Cardiol Rev. 2004;12(4):201-21.
Magee L, von Dadelszen P. Prevention and treatment of
postpartum hypertension. Cochrane Database of Systematic
Reviews. 2013;4:CD004351.
Dennis AT. Management of pre-eclampsia: issues for
anaesthetists. Anaesthesia. 2012;67(9):1009-20.
Toirac A, Pascual V, Deulofeu I, Mastrapa K, Torres Y.
Hipertensión arterial durante el embarazo, el parto y el
puerperio. Medisan. 2010;14(5):685-701.
Foo L, Tay J, Lees CC, McEniery CM, Wilkinson IB. Hypertension
in Pregnancy: Natural History and Treatment Options. Curr
Hypertens Rep. 2015;17(5):36.
Agudelo ML, Agudelo LM, Castaño JJ, Giraldo JF, Hoyos AF,
Lara AM, et al. Prevalencia de los trastornos hipertensivos
del embarazo en mujeres embarazadas controladas en
ASSBASALUD E.S.E. Manizales (Colombia), 2006 a 2008. Arch
Med Manizales. 2010;10(2)130-50.
Garovic VD, Hayman SR. Hypertension in pregnancy: an
emerging risk factor for cardiovascular disease. Nat Clin Pract
Nephrol. 2007;3(11):613-22.
Morris EA, Hale SA, Badger GJ, Magness RR, Bernstein IM.
Pregnancy induces persistent changes in vascular compliance
in primiparous women. Am J Obstet Gynecol. 2005;212(5):633.
e1-6.
Kaaja RJ, Greer IA. Manifestations of Chronic Disease During
Pregnancy. JAMA. 2005;294(21):2751-7.
Royal College of Obstetricians and Gynaecologists. Hypertension
in pregnancy: the management of hypertensive disorders during
pregnancy. NICE Clinical Guidelines. London: Royal College of
Obstetricians and Gynaecologists; 2010.
Ghanem FA, Movahed A. Use of antihypertensive drugs during
pregnancy and lactation. Cardiovasc Ther. 2008;26(1):38-49
Magriples U, Boynton MH, Kershaw TS, Duffany KO, Rising
SS, Ickovics JR. Blood pressure changes during pregnancy:
impact of race, body mass index, and wight gain. Am J Perinatol.
;30(5):415-24.
Ghuman N, Rheiner J, Tendler BE, White WB. Hypertension in
the postpartum woman: clinical update for the hypertension
specialist. J Clin Hypertens (Greenwich). 2009;11(12):726-33.
Santana G. Hipertensión arterial en el puerperio. Rev medica
electron. 2012;34(2):186-98.
Velásquez JA. Hipertensión posparto. Rev colomb obstet ginecol.
;56(2):141-6.
von Dadelszen P, Menzies J, Gilgoff S, Xie F, Douglas
MJ, Sawchuck D, et al. Evidence-based management for
preeclampsia. Front Biosci. 2007;12:2876-89.
Prabhu TR. Cerebrovascular complications in pregnancy and
puerperium. J Obstet Gynaecol India. 2013;63(2):108-11.
Yücesoy G, Özkan S, Bodur H, Tan T, Çalişkan E, Vural B, et
al. Maternal and perinatal outcome in pregnancies complicated
with hypertensive disorder of pregnancy: a seven year
experience of a tertiary care center. Arch Gynecol Obstet.
;273(1):43-9.
Orehek EK, Burns JD, Koyfman F, Azocar RJ, Holsapple JW,
Green DM. Postpartum trifecta: simultaneous eclamptic
intracerebral hemorrhage, PRES, and herniation due to
intracranial hypotension. Neurocrit Care. 2012;17(3):434-8.
Spaan J, Peeters L, Spaanderman M, Brown M. Cardiovascular
Risk Management After a Hypertensive Disorder of Pregnancy.
Hypertension. 2012;60(6):1368-73.
Romero-Arauz JF, Morales-Borrego E, García-Espinosa M,
Peralta-Pedrero ML. Guía de práctica clínica: Preeclampsia-
Roberts JM, Pearson G, Cutler J, Lindheimer M. Summary of the
NHLBI Working Group on Research on Hypertension During
Pregnancy. Hypertension. 2003;22(2):109-27.
Matthys LA, Coppage KH, Lambers DS, Barton JR, Sibai BM.
Delayed postpartum preeclampsia: An experience of 151 cases.
Am J Obstet Gynecol. 2004;190(5):1464-6.
Sibai BM, Barton JR. Expectant management of severe
preeclampsia remote from term: patient selection, treatment,
and delivery indications. Am J Obstet Gynecol. 2007;196(6):514.
e1-9.
Sibai BM, Stella CL. Diagnosis and management of atypical
preeclampsia-eclampsia. Am J Obstet Gynecol. 2009;200(5):481.
e1-7.
Sibai BM. Management of late preterm and early-term
pregnancies complicated by mild gestational hypertension/preeclampsia.
Semin Perinatol. 2011;35(5):292-6.
Sibai BM. diagnosis and management of gestational hypertension
and preeclampsia. Obstet Gynecol. 2003;102(1):181-92.
Barton JR, Sibai BM. Pediction and Prevention of Recurrent
Preeclampsia. Obstet Gynecol. 2008;112(2):359-72.
Fontenot MT, Lewis DF, Frederick B, Wang Y, DeFranco EA,
Groome LJ, et al. A prospective randomized trial of magnesium
sulfate in severe preeclampsia: Use of diuresis as a clinical
parameter to determine the duration of postpartum therapy. Am
J Obstet Gynecol. 2005;192(6):1788-94.
Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium
supplementation during pregnancy for preventing hypertensive
disorders and related problems. Cochrane Database of Sys Rev.
;(8): CD001059.
Vila C, Pipa A, Portugal A, Campos S. Management of
postpartum hypertension. Int J Gynaecol Obstet. 2009;107
Suppl 2:S413-S729.
Sibai BM. Calcium supplementation during pregnancy reduces
risk of high blood pressure, pre-eclampsia and premature birth
compared with placebo?. Evid Based Med. 2011;16(2):40-1.
Rios FG, Risso-Vázquez A, Alvarez J, Vinzio M, Falbo P,
Rondinelli N, et al. Clinical Characteristics and outcomes of
obstetric patients admitted to the intensive care unit. Int J
Gynaecol Obstet. 2012;119(2):136-40.
Graeber B, Vanderwal T, Stiller RJ, Werdmann MJ. Late
postpartum eclampsia as an obstetric complication seen in the
ED. Am J Emerg Med. 2005;23(2):168-70.
Yancey LM, Withers E, Bakes K, Abbott J. Postpartum
preeclampsia: emergency department presentation and
management. J Emerg Med. 2011;40(4):380-4.
Firoz T, Melnik T. Postpartum evaluation and long term
implications. Best Pract Res Clin Obstet Gynaecol.
;25(4):549-61.
Di Marco I, Basualdo MN, Di Pietrantonio E, Paladino S,
Inglide M, Domergue G, et al. Guía de Práctica Clínica: Estados
hipertensivos del embarazo 2010. Rev. Hosp. Mat. Inf. Ramón
Sardá. 2011;30(1):70-93.
Noronha-Neto C, Katz L, Coutinho IC, Maia SB, Souza AS,
Amorim MM. Clonidine versus captopril for treatment of
postpartum very high blood pressure: study protocol for a
randomized controlled trial (CLONCAP). Reprod Health.
;10:37.
Sibai BM, Koch MA, Freire S, Pinto e Silva JL, Rudge MV,
Martins-Costa S, et al. The impact of prior preeclampsia on the
risk of superimposed preeclampsia and other adverse pregnancy
outcomes in patients with chronic hypertension. Am J Obstet
Gynecol. 2011;204(4):345.e1-6.
Dhakal G, Subedi M, Paudel K. Magnesium Sulphate in
Management of Severe Pre-eclampsia and Eclampsia. J Nepal
Health Res Counc. 2012;10(21):113-7.
Ascarelli MH, Johnson V, McCreary H, Cushman J, May WL,
Martin JN Jr. Postpartum preeclampsia management with
furosemide: a randomized clinical trial. Obstet Gynecol.
;105(1):29-33.
Sibai BM. Diagnosis, prevention, and management of eclampsia.
Obstet Gynecol. 2005;105(2):402-10.
Barrilleaux PS, Martin JN Jr, Klauser CK, Bufkin L, May
WL. Postpartum intravenous dexamethasone for severely
preeclamptic patients without hemolysis, elevated liver
enzymes, low platelets (HELLP) syndrome: a randomized trial.
Obstet Gynecol. 2005;105(4):843-8.
Jim B, Sharma S, Kebede T, Acharya A. Hypertension
in pregnancy: a comprehensive update. Cardiol Rev.
;18(4):178-89.
Vigil-De Gracia P, Ruiz E, López JC, de Jaramillo IA, Vega-Maleck JC,
Pinzón J. Management of severe hypertension in the postpartum
period with intravenous hydralazine or labetalol: a randomized
clinical trial. Hypertens Pregnancy. 2007;26(2):163-71.
Fletcher JJ, Kramer AH, Bleck TP, Solenski NJ. Overlapping
features of eclampsia and postpartum angiopathy. Neurocrit
Care. 2009;11(2):199-209.
Fanelli C, Fernandes BH, Machado FG, Okabe C, Malheiros DM,
Fujihara CK, et al. Effects of losartan, in monotherapy or in
association with hydrochlorothiazide, in chronic nephropathy
resulting from losartan treatment during lactation. Am J Physiol
Renal Physiol. 2011;301(3):F580-7.
Ruiz R, Gil R. Hipertensión arterial post-parto. Rev Med La Paz.
;20(1):28-33.
James PA, Oparil S, Carter BL, Cushman WC, DennisonHimmelfarb
C, Handler J, et al. 2014 Evidence-Based Guidelines
for the Management of High Blood Pressure in Adults. Report
From the Panel Members Appointed to the Eighth Joint National
Committee (JNC 8). JAMA. 2014;311(5):507-20.
Toirac AS, Pascual V, Deulofeu I, Mastrapa K, Torres Y.
Hipertensión arterial durante el emabarazo, el parto y el
puerperio. MEDISAN [Internet]. 2010 [Citado 17 Julio
;14(5). Disponible en: http://bvs.sld.cu/revistas/san/
vol_14_5_10/san13510.htm
Turner JA. Diagnosis and management of pre-eclampsia: an
update. Int J Womens Health. 2010;2:327-37.
Magee LA, Abalos E, von Dadelszen P, Sibai B, Easterling T,
Walkinshaw S, et al. How to manage hypertension in pregnancy
effectively. Br J Clin Pharmacol. 2011;72(3):394-401.
Eyal S, Kim JD, Anderson GD, Buchanan ML, Brateng DA, Carr
D, et al. Atenolol pharmacokinetics and excretion in breast milk
during the first 6 to 8 months postpartum. J Clin Pharmacol.
;50(11):1301-9.
Anderson GD, Carr DB. Effect of Pregnancy on the
Pharmacokinetics of Antihypertensive Drugs. Clin
Pharmacokinet. 2009;48(3):159-68.
Podymow T, August P. Update on the use of antihypertensive
drugs in pregnancy. Hypertension. 2008;51(4):960-9.
Podymow T, August P. Antihypertensive drugs in pregnancy.
Semin Nephrol. 2011;31(1):70-85.
Podymow T, August P, Umans JG. Antihypertensive therapy in
pregnancy. Semin Nephrol. 2004;24(6):616-25.
Koual M, Abbou H, Carbonnel M, Picone O, Ayoubi JM. Shortterm
outcome of patients with preeclampsia. Vasc Health Risk
Manag. 2013;9:143-8.
James PR, Nelson-Piercy C. Management of hypertension before,
during, and after pregnancy. Heart. 2004;90:1499-1504.
Duley L,Meher S, Jones L. Drugs for treatment of very high blood
pressure during pregnancy. Cochrane Database of Systematic
Reviews [Internet]. 2013 [Citado 17 Julio 2015], Issue 7. Art.
No.: CD001449. Disponible en: http://onlinelibrary.wiley.com/
doi/10.1002/14651858.CD001449.pub3/pdf
Barton JR, Barton LA, Istwan NB, et al. Elective delivery at 340/7
to 366/7 weeks’ gestation and its impact on neonatal outcomes
in women with stable mild gestational hypertension. Am J
Obstet Gynecol. 2011;204:44.e1-5.
Sibai BM, Koch MA, Freire S, et al. The impact of prior
preeclampsia on the risk of superimposed preeclampsia and
other adverse pregnancy outcomes in patients with chronic
hypertension. Am J Obstet Gynecol. 2011;204(4):345.e1-6.
Clark SL. Strategies for Reducing Maternal Mortality. Semin
Perinatol. 2012;36:42-7.
Fontenla A, García-Donaire JA, Hernández F, Segura J, Salgado
R, Cerezo C, et al. Management of Resistant Hypertension in
a Multidisciplinary Unit of Renal Denervation: Protocol and
Results. Rev Esp Cardiol. 2013;66(5):364-70.
Clark SL, Hankins GDV. Preventing Maternal Death: 10 Clinical
Diamonds. Obstet Gynecol. 2012;119(2 Pt1):360-4.
Spaan JJ, Sep SJS, Lopes van Balen V, Spaanderman MEA, Peeters
LLH. Metabolic Syndrome as a Risk Factor for Hypertension
After Preeclampsia. Obstet Gynecol. 2012;120:311-7.
Sibai BM. Management of late preterm and early-term pregnancies complicated by mild gestational hypertension/pre-eclampsia.
Semin Perinatol. 2011;35(5):292-6.
McCarthy F, Kenny LC. Hypertension in pregnancy. Obstet
Gynaecol Reprod Med. 2015;25(8):229-35.