Effects of antihypertensive therapy on pre- and postnatal maternal hemodynamics

Abstract

Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular impairment reflected by abnormal maternal hemodynamics. Current treatment strategies target blood pressure rather than the maternal hemodynamic profile. Therefore, this study evaluated the effects of antihypertensive treatment on cardiovascular parameters in women with HDP, healthy pregnant women, and in a preeclamptic rat model. METHODS: This multicenter, prospective translational case-control study was conducted at the Medical University of Vienna and the Max Delbruck Center for Molecular Medicine, Berlin, between July 2019 and July 2024. Cardiovascular parameters including cardiac output, stroke volume, systemic vascular resistance, and inotropy index were measured pre- and posttreatment with α-methyldopa as well as postnatally using the USCOM 1A Monitor. In the rat model, the effects of α-methyldopa, nifedipine, and labetalol were evaluated. RESULTS: A total of 238 women were included: 132 with HDP (69 gestational hypertension, 63 preeclampsia) and 106 controls. In gestational hypertension, treatment led to increased cardiac output (median, 0.38 L/min [95% CI, 0.06-0.71]; P=0.021) and a decrease in systemic vascular resistance (median, -0.08 log dynes/s per cm-5 [95% CI, -0.14 to -0.03]; P=0.005). In preeclampsia, no significant hemodynamic changes were observed. Systemic vascular resistance remained elevated and stroke volume index reduced in both HDP groups up to 1-year postpartum. Similar patterns were observed in the preeclamptic rat model, with persistently increased vascular resistance and reduced cardiac output and stroke volume. CONCLUSIONS: Antihypertensive therapy does not influence cardiovascular impairment despite lowering blood pressure in preeclampsia. Novel therapeutic approaches are needed to improve maternal cardiovascular health after HDP.