{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:26:17Z","timestamp":1785839177573,"version":"3.56.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,1,5]],"date-time":"2017-01-05T00:00:00Z","timestamp":1483574400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The King's College Hospital Charity","award":["230729"],"award-info":[{"award-number":["230729"]}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine whether treatment for hypertension in pregnancy that is guided by serial monitoring of maternal central hemodynamics leads to a reduction in the rate of severe hypertension, defined as blood pressure \u2265 160\/110 <jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content>; and to assess the distinct longitudinal hemodynamic profiles associated with beta\u2010blocker monotherapy, vasodilator monotherapy and dual agent therapy, and their relationships with outcomes, including fetal growth restriction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study at a dedicated antenatal hypertension clinic in a tertiary <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> hospital. Fifty\u2010two untreated women presenting with hypertension were recruited consecutively and started on treatment, either with a beta\u2010blocker or a vasodilator. The choice of initial antihypertensive agent was determined according to a model constructed previously to predict the response to the beta\u2010blocker labetalol in pregnant women needing antihypertensive treatment. At presentation, the demographic and maternal hemodynamic variables associated with a therapeutic response to labetalol, defined as blood pressure control &lt; 140\/90 <jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content> with labetalol monotherapy throughout pregnancy, were ascertained and analyzed with logistic regression to create a model to predict sustained blood pressure control as described above. The women were reviewed regularly until delivery and underwent serial hemodynamic monitoring throughout pregnancy. If their blood pressure was elevated, the prediction model was referred to again to determine if alternative antihypertensive therapy, either with additional beta\u2010blocker or a vasodilator, should be added.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Treatment by referring to results of serial hemodynamic monitoring reduced the rate of severe antenatal hypertension from 18% to 3.8%. Seventy\u2010seven percent of women were initially prescribed a beta\u2010blocker and 23% a vasodilator. The group that maintained good blood pressure control with beta\u2010blocker monotherapy had the best fetal and maternal outcomes. They had lower blood pressures at presentation and throughout gestation, demonstrated well\u2010maintained cardiac output and had the lowest rates of fetal growth restriction. The groups that required dual therapy to control their blood pressure had persistently higher blood pressure and rate of fetal growth restriction. The groups that required vasodilator therapy due to high levels of peripheral vascular resistance, either at presentation or later in pregnancy, accounted for 81% of cases with fetal growth restriction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using serial hemodynamic monitoring in pregnancy to guide treatment of hypertension significantly reduces the rate of severe hypertension and allows identification of high\u2010resistance, low\u2010output hypertensive pregnancies that are associated with an increased rate of fetal growth restriction. Copyright \u00a9 2016 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><jats:p><jats:bold>RESUMEN<\/jats:bold><\/jats:p><\/jats:sec><jats:sec><jats:title>Objetivos<\/jats:title><jats:p>Examinar si el tratamiento para la hipertensi\u00f3n en el embarazo guiado por un seguimiento en serie de las principales constantes hemodin\u00e1micas de la madre conduce a una reducci\u00f3n en la tasa de hipertensi\u00f3n grave, definida como presi\u00f3n arterial \u2265 160\/110 <jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content>; y evaluar los diferentes perfiles hemodin\u00e1micos longitudinales asociados a la monoterapia con beta\u2010bloqueantes, la monoterapia con vasodilatadores y la terapia dual, y su relaci\u00f3n con los resultados, como la restricci\u00f3n del crecimiento fetal.<\/jats:p><\/jats:sec><jats:sec><jats:title>M\u00e9todos<\/jats:title><jats:p>Se realiz\u00f3 un estudio observacional prospectivo en una cl\u00ednica especializada en hipertensi\u00f3n prenatal de un hospital de atenci\u00f3n terciaria del Reino Unido.<\/jats:p><jats:p>Se reclutaron consecutivamente a cincuenta y dos mujeres no tratadas que presentaban hipertensi\u00f3n y se comenz\u00f3 a tratarlas, bien con un beta\u2010bloqueante o bien con un vasodilatador. La elecci\u00f3n del agente antihipertensivo inicial se determin\u00f3 de acuerdo con un modelo elaborado previamente para predecir la respuesta al beta\u2010bloqueante labetalol en mujeres embarazadas que necesitaban tratamiento antihipertensivo.<\/jats:p><jats:p>Al inicio se registraron las caracter\u00edsticas demogr\u00e1ficas y las variables hemodin\u00e1micas maternas asociadas con una respuesta terap\u00e9utica al labetalol, definida como un control de la presi\u00f3n arterial &lt; 140\/90 <jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content> con monoterapia de labetalol durante todo el embarazo que se analiz\u00f3 mediante regresi\u00f3n log\u00edstica para crear un modelo con el que pronosticar un control sostenido de la presi\u00f3n arterial, como se describe arriba.<\/jats:p><jats:p>Las mujeres fueron sometidas a revisiones regulares hasta el momento del parto y se les hizo un seguimiento hemodin\u00e1mico en serie durante todo el embarazo.<\/jats:p><jats:p>Si la presi\u00f3n arterial era elevada, se emple\u00f3 de nuevo el modelo de predicci\u00f3n para determinar si se deber\u00eda a\u00f1adir un tratamiento antihipertensivo alternativo, ya sea con un beta\u2010bloqueante adicional o con un vasodilatador.<\/jats:p><\/jats:sec><jats:sec><jats:title>Resultados<\/jats:title><jats:p>El tratamiento que tuvo en cuenta los resultados del seguimiento hemodin\u00e1mico en serie redujo la tasa de hipertensi\u00f3n prenatal grave del 18% al 3,8%.<\/jats:p><jats:p>Al 77% de las mujeres se les recet\u00f3 inicialmente un y al 23% un vasodilatador. El grupo que mantuvo un buen control de la presi\u00f3n arterial con monoterapia de beta\u2010bloqueantes logr\u00f3 mejores resultados fetales y maternos.<\/jats:p><jats:p>Este grupo tuvo menor presi\u00f3n arterial al inicio y durante toda la gestaci\u00f3n, mostr\u00f3 un gasto card\u00edaco en buen estado y tuvo las tasas m\u00e1s bajas de restricci\u00f3n del crecimiento fetal. Los grupos que requirieron terapia dual para controlar su presi\u00f3n arterial mostraron persistentemente una mayor presi\u00f3n arterial y un mayor ritmo de restricci\u00f3n del crecimiento fetal. Los grupos que requirieron tratamiento vasodilatador debido a los altos niveles de resistencia vascular perif\u00e9rica, tanto al inicio como durante el embarazo, representaron el 81% de los casos con restricci\u00f3n del crecimiento fetal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusi\u00f3n<\/jats:title><jats:p>El uso de un seguimiento hemodin\u00e1mico en serie en el embarazo como gu\u00eda para el tratamiento de la hipertensi\u00f3n reduce significativamente la tasa de hipertensi\u00f3n severa y permite la identificaci\u00f3n de embarazos con hipertensi\u00f3n de alta resistencia y malos resultados, asociados con una mayor tasa de restricci\u00f3n del crecimiento 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