title: Medical treatment of early-onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications.
abstract: OBJECTIVE
  Complications in early-onset mild gestational hypertension (GH) are better predicted by total peripheral vascular resistance (TPVR) > 1350 dyne than by blood pressure. We therefore aimed to assess the possible reduction of severe complications by lowering TPVR with nitric oxide (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 blood pressure < 170/110 mmHg) and TPVR > 1350 dyne were enrolled in a prospective non-randomized trial with sequential allocation: 100 patients were treated with nifedipine (Group A); 100 with nifedipine and NO donors (Group B); 100 with nifedipine and oral fluids (Group C); and 100 with nifedipine, NO donors and oral fluids (Group D). TPVR was checked 1 month after initiation of therapy, and the number of patients with severe maternal and fetal complications was recorded in each group. The relationship between reduction in TPVR and the frequency of severe complications was assessed.
  
  
  RESULTS
  Severe complications developed in 51% of patients in Group A, 48% in Group B, 53% in Group C and 35% in Group D, the frequency in Group D being significantly lower than that in the other treatment groups (P < 0.05). A reduction in TPVR of < 15% predicted the occurrence of severe complications with sensitivity 95.2% and specificity 88.3%. In Group D a reduction in TPVR of ≥ 15% was more probable (odds ratio (OR) = 2.03; 95% CI, 1.15-3.60; P < 0.015) and severe complications were less probable (OR = 0.52; 95% 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.
authors.affiliation: Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy. bgp.novelli@tiscali.it
authors.forename: B
authors.initials: B
authors.lastname: Vasapollo
authors.forename: G P
authors.initials: GP
authors.lastname: Novelli
authors.forename: G
authors.initials: G
authors.lastname: Gagliardi
authors.forename: G M
authors.initials: GM
authors.lastname: Tiralongo
authors.forename: I
authors.initials: I
authors.lastname: Pisani
authors.forename: D
authors.initials: D
authors.lastname: Manfellotto
authors.forename: L
authors.initials: L
authors.lastname: Giannini
authors.forename: H
authors.initials: H
authors.lastname: Valensise
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004452:Echocardiography; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy*; D008875:Middle Aged; D009543:Nifedipine / Q000494:pharmacology / Q000627:therapeutic use*; D020030:Nitric Oxide Donors / Q000494:pharmacology / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014655:Vascular Resistance / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D020030:Nitric Oxide Donors; D009543:Nifedipine