Tag Archive 'embarazo e hipertensión'

Miércoles 5 / junio / 2013

Antihypertensive drug therapy for mild to moderate hypertension during pregnancy (Review)

Filed under: Revisiones — Mario Hernández Cueto — junio 5th, 2013 — 13:15

Antihypertensive drug therapy for mild to moderate hypertension during pregnancy (Review)

CochranePor: Abalos E, Duley L, Steyn DW y Henderson-Smart DJ. The Cochrane Collaboration. 2012, Issue 10. (Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD002252.).

Mild to moderate hypertension during pregnancy is common. Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease, and thereby improve. To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy outcome. It remains unclear whether antihypertensive drug therapy for mild to moderate hypertension during pregnancy is worthwhile.
Whether the reduction in the risk of severe hypertension is considered sufficient to warrant treatment is a decision that should be made by women in consultation with their obstetrician. If an antihypertensive is used, there is insufficient evidence to conclude that one antihypertensive is better than another.The choice should therefore depend on the previous experience of the clinician and the woman’s preference. [Actualizado: 5 de junio 2013].

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Jueves 2 / mayo / 2013

Hipertensión durante el embarazo, mayor riesgo de sufrir sudoración nocturna

Filed under: noticia — Mario Hernández Cueto — mayo 2nd, 2013 — 7:36

Hipertensión durante el embarazo, mayor riesgo de sufrir sudoración nocturna

embarazada-sudandoLas mujeres que padecen de hipertensión arterial durante la gestación tienen mayor riesgo de sufrir sofocos y sudoración nocturna en la según un artículo publicado en Menopause.

Los expertos investigaron la relación entre las enfermedades hipertensivas durante el embarazo como la preeclampsia y los síntomas vasomotores en 853 mujeres que visitaron al cardiólogo en Kampen, Países Bajos.

De estas, 274 mujeres sufrieron enfermedades hipertensivas durante el embarazo y experimentaron sofocos más intensos y sudoración nocturna.

Debido a que la mitad de las mujeres del estudio sufrieron síntomas cardiacos, los investigadores no tienen claro si esta asociación se puede ligar a las mujeres de mediana edad.

(Fuente: Diario Médico, referido por Aldía) [Actualizado: 02 de mayo 2013]

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Lunes 26 / noviembre / 2012

New Risk Factor Identified for High Blood Pressure during Pregnancy

Filed under: noticia — Mario Hernández Cueto — noviembre 26th, 2012 — 10:24

New Risk Factor Identified for High Blood Pressure during Pregnancy

Mujer embarazada e hipertensaPreeclampsia is a serious complication of pregnancy and the major cause of death for both mother and child in Europe and the U.S. It affects about one in 20 pregnancies. The main symptoms are high blood pressure and protein in the urine. The cause of preeclampsia is still unclear. Dr. Florian Herse (Experimental and Clinical Research Center (ECRC) of the Max Delbrück Center (MDC) and the Charité), Dr. Ralf Dechend (ECRC and Helios Klinikum Berlin-Buch) and their collaborators have now identified an enzyme that is overexpressed in affected women and thus apparently contributes to development of the condition. In animal experiments, the researchers inhibited this enzyme and were able to ameliorate the disease process (10.1161/CIRCULATIONAHA.112.127340).

Preeclampsia originates in the placenta, which supplies the embryo/fetus in the womb with nutrients. For their study, Dr. Herse, numerous contributors, and Dr. Dechend analyzed tissue samples from 25 women diagnosed with preeclampsia and from 23 healthy pregnant women as controls. The tissue samples of the preeclamptic women were obtained from hospitals in Finland, Norway, Austria, and the U.S. that cooperated closely in the study.

Using gene-chip technology, the researchers in Berlin analyzed the expression of almost 40,000 genes. They found that in women with preeclampsia, levels of the CYP2J2 enzyme were unusually high in placental cells and the uterine lining (decidua). The placenta consists of fetal cells; the decidua, by contrast, is solely maternal tissue. The enzyme is involved in the production of specific metabolites called EETs (epoxyeicosatrienoic acids) which, among other things, regulate inflammatory processes, vascular growth, and blood pressure.

Dr. Herse and team succeeded in identifying the cells that produce the CYP2J2 enzyme as trophoblasts, which fulfill an important function in pregnancy. These fetal cells migrate from the placenta into the maternal decidua. Trophoblasts are key contributors to spiral-artery remodeling and thus ensure that the fetus is sufficiently supplied with nutrients. However, if the trophoblasts do not grow deeply enough into the decidua, this remodeling process is disturbed. As a consequence, the fetus cannot be sufficiently supplied with nutrients, leading to preeclampsia. EETs evidently have a harmful effect because they activate a substance which prevents the trophoblasts from growing into the decidua.

Both a protective and damaging effect

Previous studies indicated that EETs exert only positive effects on the cardiovascular system. EETs generally mediate vascular expansion and reduce blood pressure. They also protect the tissue from dying of oxygen deficiency. In normal pregnancies EET levels are slightly elevated.

Previous experiments with healthy pregnant rats showed that pharmacological inhibition of the CYP2J2 enzyme and the associated inhibition of EET production lead to hypertension and kidney failure. In pregnant rats with preeclamptic symptoms, however, opposite effects may occur. By inhibiting CYP2J2, the ECRC researchers were able to lower blood pressure levels in these animals.

How did these conflicting observations come about? Dr. Herse and team demonstrated that the EETs can be converted into other metabolites. A specific enzyme (cyclooxygenase, COX) alters these components further in such a way that they cause vasoconstriction and thus an increase in blood pressure. EETs that normally lower blood pressure can evidently produce metabolites that cause blood pressure to rise in preeclampsia. If however the researchers inhibited the cyclooxygenase in the pregnant animals, the EETs were not converted further and the blood pressure did not increase. “This work shows that the increased production of EET in the placenta and the conversion via cyclooxygenase into hormones that increase blood pressure both favor the development of preeclampsia,” Dr. Herse and Dr. Dechend explained.

Messenger substance of the immune system apparently promotes the development of preeclampsia

But why do the bodies of women with preeclampsia produce more CYP2J2 and thus more EET? Tumor necrosis factor-alpha (TNF-alpha), a chemical messenger of the immune system, could possibly contribute. This signaling substance is released at early stages of pregnancy whenever placental blood flow is too low, causing oxygen deficiency. As the researchers showed, TNF-alpha promotes the production of CYP2J2 and EET in the placenta. In other tissues, this reaction would be useful, since EET rescues tissue from dying that has an insufficient supply of blood and therefore of oxygen. In the placenta, by contrast, this boost in production of CYP2J2 and EET could lead to a vicious circle. The trophoblasts do not grow as well into the decidua and the blood vessels and are not remodeled correctly, so that blood flow through the placenta and blood supply to the fetus deteriorates. As a consequence, the mothers becomes hypertensive and EETs under these conditions is converted in such a way that the blood pressure continues to increase.

Treatment of preeclampsia, which according to estimates costs many thousands of maternal lives across the globe every year, remains difficult. The only possibility is to induce delivery at an early stage if the clinical presentation is severe. In Germany, preeclampsia is the cause for up to 20,000 premature births annually. Once the child is born, the symptoms subside in the mother. Nevertheless, she may suffer long-term increased risk for cardiovascular disease and develop heart attack, stroke, or hypertension at an early age. For the child, depending on the stage of fetal development, the premature birth may result in death or severe lifelong disability, and the child may also have an increased risk for cardiovascular disease later on. The research conducted by Dr. Herse, the entire team, and Dr. Dechend implicates a previously unknown mechanism. Their discovery may contribute to a better understanding of the disease process and its causes, and may ultimately aid in developing a therapy.

(Fuente: http://www.mdc-berlin.de) [publicada: 22 de noviembre 2012] [publicada en la página: 26 de nov. 2012]

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Viernes 14 / septiembre / 2012

Más mujeres embarazadas toman antihipertensivos, según un estudio

Filed under: noticia — Mario Hernández Cueto — septiembre 14th, 2012 — 8:06

Más mujeres embarazadas toman antihipertensivos, según un estudio

Mujer embarazada e hipertensaLos expertos consideran a algunos medicamentos más seguros que otros para el feto en desarrollo

Un número creciente de mujeres embarazadas toman medicamentos para tratar la hipertensión, indica una investigación reciente.

“Los motivos del aumento no están del todo claros”, señaló el autor del estudio, el Dr. Brian Bateman, profesor asistente de anestesia de la Facultad de Medicina de la Universidad de Harvard.

Aunque la gestión de la hipertensión durante el embarazo es importante, ciertos fármacos se prefieren, debido a su perfil de seguridad. En el estudio, Bateman, halló que muchas mujeres no tomaban esos fármacos.

“Necesitamos más investigación para averiguar qué medicamentos son mejores para asegurar un buen resultado del embarazo tanto para la madre como para el bebé”, planteó.

Los hallazgos aparecen en la edición de octubre de la revista Hypertension.

Bateman y colegas examinaron reclamaciones de Medicaid de 2000 a 2007, en búsqueda de los expedientes de mujeres que habían completado embarazos. De más de un millón de mujeres, casi 48,500 (4.4 por ciento) tomaban antihipertensivos en el embarazo. Desde el inicio hasta el final del estudio, la proporción de mujeres que tomaban los fármacos aumentó de 3.5 a 4.9 por ciento.

Algunas tomaban los medicamentos antes del embarazo, dijo Bateman. Otras desarrollaron hipertensión durante el embarazo, y se les administraron los medicamentos.

La gama de antihipertensivos varió ampliamente, halló Bateman. Con frecuencia, las mujeres tomaban medicamentos distintos de la metildopa (Aldomet) o el labetalol (Normadyne, Trandate), los dos fármacos que por lo general se recomiendan durante el embarazo.

Otros medicamentos, entre ellos los inhibidores de la ECA, no deben usarse en el embarazo, según el Congreso Estadounidense de Obstetras y Ginecólogos (American Congress of Obstetricians and Gynecologist), debido a posibles perjuicios para el feto en desarrollo.

Para todos los antihipertensivos, 1.9 por ciento de las mujeres los tomaron en el primer trimestre, 1.7 por ciento en el segundo trimestre, y 3.2 por ciento en el tercer trimestre. Para los inhibidores de la ECA, el 4.9 por ciento de las mujeres los tomaron durante el segundo trimestre, y 1.1 por ciento en el tercer trimestre.

Bateman halló que las mujeres que tomaban antihipertensivos tendían a ser mayores que las que no los tomaban. Eran más propensas a ser blancas o negras, en comparación con otras etnias. Eran más propensas que las que no los usaban a sufrir de diabetes y enfermedad renal.

Aunque el estudio de Bateman no observó el motivo del aumento en el número de mujeres que toman antihipertensivos, especuló que la epidemia de obesidad y que las mujeres retrasen el embarazo hasta tener más edad (y un mayor riesgo de desarrollar hipertensión) podrían explicar el aumento.

Una mayor edad materna podría de hecho explicar gran parte del aumento, según la Dra. Suzanne Steinbaum, directora de mujeres y enfermedad cardiaca del Instituto Cardiaco y Vascular del Hospital Lenox Hill, en la ciudad de Nueva York.

“Cuando observo a mis pacientes [embarazadas], no son obesas, solo un poco mayores”, apuntó. “Observamos un grupo distinto de mujeres respecto a antes, mujeres que tienen más edad y que quizás estén más enfermas, y que tienen bebés”.

Steinbaum enfatizó que definitivamente hay que tratar la hipertensión en el embarazo. Sin embargo, algunos de los fármacos son peligrosos para el bebé. La metildopa y el labetalol se consideran como los más seguros, concurrió Steinbaum. “Cuentan con un historial de seguridad”, aseguró.

¿Cuál es su consejo? “Si piensa en quedar embarazada y sufre de hipertensión y toma fármacos, hable con el médico. Quizás esté tomando un medicamento que no sea seguro [durante el embarazo]”.

“Creo que esto se ha estudiado poco”, señaló, respecto a la seguridad de los antihipertensivos durante el embarazo.

Los Institutos Nacionales de Salud de EE. UU. y la Agencia para la Investigación y la Calidad de la Atención de Salud financiaron la investigación.

(Fuente: Medlineplus/spanish/news)

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