Resumen
Introducción: La hipertensión arterial posparto incrementa el riesgo de complicaciones agudas y crónicas en las pacientes con preeclampsia. El losartán puede ser una opción farmacológica útil.
Objetivo: Determinar los resultados del tratamiento de la hipertensión arterial posparto con losartán en pacientes con preeclampsia grave.
Método: Ensayo clínico no controlado en 49 pacientes con preeclampsia grave. Luego de la interrupción gestacional se formaron dos grupos: el grupo A (n = 24) recibió el régimen antihipertensivo estándar (metildopa 1500 mg/día, hidralazina 200 mg/día, metoprolol 200 mg/día) y el grupo B (n = 25) recibió el mismo tratamiento más losartán 100 mg/día por 90 días. En ambos grupos, la metildopa, la hidralazina y el metoprolol se redujeron o suspendieron en este orden; en el grupo B, el losartán se mantuvo con la misma o media dosis sin ser suspendido. Se compararon los valores basales y finales (día 90) de la presión arterial sistólica (PAS) y diastólica (PAD). Se usó estadística descriptiva e inferencial (t de Student para muestras emparejadas, U de Mann-Whitney, prueba de los rangos con signo de Wilcoxon). Se consideró significativa una p < 0.05.
Resultados: Grupo A: PAS basal 135.46 ± 13.88 frente a final 109.76 ± 10.54 mmHg (p < 0.001) y PAD basal 85.71 ± 10.17 frente a final 72.14 ± 10.55 mmHg (p < 0.001). Grupo B: PAS basal 135.84 ± 14.39 frente a final 110.68 ± 9.79 mmHg (p < 0.001) y PAD basal 83.08 ± 9.58 frente a final 72.61 ± 9.16 mmHg (p < 0.001).
Conclusiones: Ambos tratamientos redujeron de manera similar la PAS y la PAD en la medición a 90 días.
Abstract
Background: Postpartum hypertension increases the risk of acute and chronic complications in patients with preeclampsia. Losartan may be a useful drug alternative.
Objective: To determine the results of treatment of postpartum hypertension with losartan in patients with severe preeclampsia.
Method: Uncontrolled clinical trial in 49 patients with severe preeclampsia. After gestational interruption, two groups were formed: group A (n = 24) received the standard antihypertensive regimen (methyldopa 1500 mg/day, hydralazine 200 mg/ day, metoprolol 200 mg/day), and group B (n = 25) the same treatment plus losartan 100 mg/day for 90 days. In both groups, methyldopa, hydralazine and metoprolol was reduced or suspended in that order; in group B, losartan was maintained with the same or half the dose without suspending it. Baseline and final values (day 90) of systolic (SBP) and diastolic blood pressure (DBP) were compared. Descriptive and inferential statistics were applied (Student’s t test for paired samples, Mann-Whitney U test, Wilcoxon’s signed rank test). It was significant a p < 0.05.
Results: Group A: baseline SBP 135.46 ± 13.88 vs. final 109.76 ± 10.54 mmHg (p < 0.001) and basal DBP 85.71 ± 10.17 vs. final 72.14 ± 10.55 mmHg (p < 0.001). Group B: basal SBP 135.84 ± 14.39 vs. final 110.68 ± 9.79 mmHg (p < 0.001) and baseline DBP 83.08 ± 9.58 vs. final 72.61 ± 9.16 mmHg (p < 0.001).
Conclusions: Both treatments similarly reduced SBP and DBP at the 90-day measurement.
1. Andrus SS, Wolfson AB. Postpartum preeclampsia occurring after resolution of antepartum ´preeclampsia. J Emerg Med. 2010;38:168-70.
2. American College of Obstetricians and Gynecologist (ACOG). Task Force on Hypertension in Pregnancy. Washington. ACOG.2013.
Disponible en:
https://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy
3. The Society of Obstetricians and Gynecologists of Canada. Clinical Practice Guideline. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary. JOGC. No.307, May 2014. Disponible en:
https://sogc.org/wp-content/uploads/2014/05/gui307CPG1405Erev.pdf
4. Guía de Práctica Clínica. Actualización 2017. Prevención, diagnóstico y tratamiento de la preeclampsia en el segundo y tercer nivel de atención. México. Secretaría de Salud. 2017.
Disponible en:
http://www.cenetec.salud.gob.mx/contenidos/gpc/catalogoMaestroGPC.html
5. Pauli JM, Reptke JT. Preeclampsia, short-term and long-term implications. Obstet Gynecol Clin N Am. 2015;42:299-313.
6. Sircar M, Thadhani R, Karumanchi SA. Pathogenesis of pre-eclampsia. Curr Opin Nephrol Hypertens. 2015; 24:131-38.
7. Rylander R. Pre-eclampsia during pregnancy and cardiovascular disease later in life: the case for a risk group. Arch Gynecol Obstet. 2015;292:519-21.
8. Orueta Sánchez R, López Gil MJ. Manejo de fármacos durante el embarazo. Inf Tec Sist Nac Salud. 2011;35:107-13.
9. Losartan. Drugs.com Know more. Be sure. Medically reviewed on April 30, 2018.
Disponible en:
https://www.drugs.com/losartan.html
10. Losartan Pregnancy and Breastfeeding Warnings. Drugs.com Know more. Be sure. Medically reviewed on May 7, 2018.
Disponible en:
https://www.drugs.com/pregnancy/losartan.html
11. Manten GT, Sikkema MJ, Voorbij HA, Visser GH, Bruinse HW, Franx A. Risk factors for cardiovascular disease in women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction. Hypertens Pregnancy. 2007;26:39–50.
12. Berends AL, de Groot CJ, Sijbrands EJ, Sie MP, Benneheij SH, Pal R, et al. Shared constitutional risks for maternal vascular-related pregnancy complications and future cardiovascular disease. Hypertension. 2008;51:1034–41.
13. Edlow AG, Srinivas SK, Elovitz MA. Investigating the risk of hypertension shortly after pregnancies complicated by preeclampsia. Am J Obstet Gynecol. 2009;200:e60–2.
14. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med. 1998;338:1128-37.
15. Phillips SJ, Whisnant JP. Hypertension and stroke. En: Laragh JH, Brenner BM, editors. Hypertension: Pathophysiology, Diagnosis, and Management. 2nd ed. New York: Raven Press; 1995. p. 465-478.
16. Makkonen N, Harju M, Kirkinen P. Postpartum recovery after severe pre-eclampsia and HELLP-syndrome. J Perinat Med. 1996;24:641–9.
17. Remuzzi G, Ruggenenti P. Prevention and treatment of pregnancy associated hypertension: what have we learned in the last 10 years? Am J Kidney Dis. 1991;18:285-305.
18. Chua S, Redman CW. Prognosis for pre-eclampsia complicated by 5 g or more of proteinuria in 24 hours. Eur J Obstet Gynecol Reprod Biol. 1992;43:9–12.
19. Stepan H, Nordmeyer AK, Faber R. Proteinuria in hypertensive pregnancy diseases is associated with a longer persistence of hypertension postpartum. J Hum Hypertens. 2006;20:125–8.
20. Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM. Preeclampsia and the risk of end-stage renal disease. N Engl J Med. 2008;359:800–9.