Hipertensi pada Kehamilan

Haidar Alatas

Abstract


Hipertensi pada kehamilan sering terjadi (6-10 %) dan meningkatkan risiko morbiditas dan mortalitas pada ibu, janin dan perinatal. Pre-eklampsia/eklampsia dan hipertensi berat pada kehamilan risikonya lebih besar. Hipertensi pada kehamilan dapat digolongkan menjadi pre-eklampsia/ eklampsia, hipertensi kronis pada kehamilan, hipertensi kronis disertai pre-eklampsia, dan hipertensi gestational. Pengobatan hipertensi pada kehamilan dengan menggunakan obat antihipertensi ternyata tidak mengurangi atau meningkatkan risiko kematian ibu, proteinuria, efek samping, operasi caesar, kematian neonatal, kelahiran prematur, atau bayi lahir kecil. Penelitian mengenai obat antihipertensi pada kehamilan masih sedikit. Obat yang direkomendasikan adalah labetalol, nifedipine dan methyldopa sebagai first line terapi. Penatalaksanaan hipertensi pada kehamilan memerlukan pendekatan multidisiplin dari dokter obsetri, internis, nefrologis dan anestesi. Hipertensi pada kehamilan memiliki tingkat kekambuhan yang tinggi pada kehamilan berikutnya. Hypertension complicates 6% to 10% of pregnancies and increases the risk of maternal, fetal and perinatal morbidity and mortality. Preeclampsia / eclampsia and severe hypertension in pregnancy are at greater risk. Four major hypertensive disorders in pregnancy have been described by the American College of Obstetricians and Gynecologists (ACOG): chronic hypertension; preeclampsia-eclampsia; chronic hypertension with superimposed preeclampsia; and gestational hypertension. The current review suggests that antihypertensive drug therapy does not reduce or increase the risk of maternal death, proteinuria, side effects, cesarean section, neonatal and birth death, preterm birth, or small for gestational age infants. The quality of evidence was low. Recommendations for treatment of hypertension in pregnancy are labetalol, nifedipine and methyldopa as first line drugs therapy. Although the obstetrician manages most cases of hypertension during pregnancy, the internist, cardiologist, or nephrologist may be consulted if hypertension precedes conception, if end organ damage is present, or when accelerated hypertension occurs. Women who have had preeclampsia are also at increased risk for hypertension in future pregnancies.


Keywords


pregnancy, hypertension, preeclampsia, antihypertensive drugs

References


1. Bartsch, E., Medcalf, K.E., Park, A.L., et al., 2016. Clinical risk factors for pre-eclamsia determined in early pregnancy: systemic review and meta-analysis of large cohort studies. BMJ. Vol 353: i1753.

2. Bateman, B.T., Huybrechts, K.F., Maeda, A., et al., 2015. Calcium Channel Blocker Exposure in Late Pregnancy and the Risk of Neonatal Seizures. Obstetrics & Gynecology. Vol 126 (2): 271.

3. Bilano, V.L., Ota, E., Ganchimeg, T., et al., 2014. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a who secondary analysis. PLOS ONE. Vol 9 (3): e91198.

4. Brown, M.A., Magee, L.A., Kenny, L.C., et al., 2018. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension. Vol 13: 291-310. https://doi.org/10.1016/j.preghy.2018.05.004.

5. Churchill, D., Beevers, G., Meher, S., et al., 2007. Diuretics for preventing pre‐eclampsia. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD004451.pub2.

6. Cluver, C., Novikova, N., Koopmans, C.M., et al., 2017. Planned early delivery versus expectant management for hypertensive disorder from 34 weeks gestation to term. Cochrane Database of Systemic Review. Vol 1.

7. Collins, R., Yusuf, S., Peto, R., 1985. Overview of randomised trials of diuretics in pregnancy. Br Med J (Clin Res Ed). Vol 290 (6461): 17-23.

8. Coutts, J., 2007. Pregnancy-induced hypertension-the effects on the newborn; in Lyall, F. and Belfort, M., Pre-eclampsia: Etiology and Clinical Practice Ch. 33. Cambridge University Press. Cambridge.

9. Dahlof B, Devereux RB, Kjeldsen SE, et al., 2002. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. Vol 359: 995-1003.

10. English, F.A., Kenny, L.C., and McCarthy, F.P., 2015. Risk factors and effective management of preeclampsia. Integrated Blood Pressure Control. Vol 8: 7-12.

11. Erwinanto, 2017. Definisi dan klasifikasi hipertensi in: Taruna, Y. and Widyantoro, B. Buku Ajar Hipertensi. Perhimpunan Dokter Hipertensi Indonesia. Jakarta.

12. Erwinanto, 2017. Klasifikasi hipertensi (primer dan sekunder) serta perjalanan penyakit in: Taruna, Y. and Widyantoro, B. Buku Ajar Hipertensi. Perhimpunan Dokter Hipertensi Indonesia. Jakarta.

13. Ferdinand, K., and Kountz, D.S., 2008. New Approaches to Managing Dyslipidemia: Risk Reduction Beyond LDL-C. Medscape. https://www.medscape.org/viewarticle/577753.

14. Hoeltzenbein, M., Beck., E., Fietz, A.K., et al., 2017. Pregnancy Outcome After First Trimester Use of Methyldopa. Hypertension. Vol 70 (1): 201-8.

15. Horvath JS, Phippard A, Korda A, Henderson-Smart DJ, Child A, Tiller DJ. Clonidine hydrochloride-a safe and effective antihypertensive agent in pregnancy. Obstet Gynecol. 1985; 66:634–8. https://doi.org/10.1016/0020-7292(87)90222-0.

16. Joesoef, A.H., dan Setianto, B., 2003. Hipertensi sekunder in: Rilantono dkk (ed). Buku Ajar Kardiologi. FKUI. Jakarta.

17. Kaplan, N.M. and Rose, D., 2010. Prehypertension and borderline hypertension. http://www.uptodate.com/store.

18. Kaplan, N.M., 2015. Primary hypertension: pathogenesis in: Kaplan, N., Rose, B., Bakris, G.L., Sheridan, A.M., Kaplan’s Clinical Hypertension, 11th ed Linppincol William & Willkins Phylladephia. Pp: 50-121.

19. Kario, 2018. Central Sympathetic Agents and Direct Vasodilators in Hypertension: A Companion to Braunwald's Heart Disease (Third Edition) Ch 26. Elsevier.

20. Karthikeyan, V.J., 2015. Hypertension in pregnancy; in Nadar, S. and Lip, G.Y.H., Hypertension, Ch. 22, 2nd Ed. Oxford Cardiology Library. Oxford.

21. Kementerian Kesehatan Republik Indonesia., 2018. Profil Kesehatan Indonesia Tahun 2017. Kemenkes RI.

22. Kementerian Kesehatan Republik Indonesia., 2017. Keputusan Menteri Kesehatan Republik Indonesia Nomor Hk.01.07/Menkes/659/2017 Tentang Formularium Nasional. Diberlakukan Tahun 2018. Kemenkes RI.

23. Khan, K., Zamora, J., Lamont, R.F., et al., 2010. Safety concerns for the use of calcium channel blockers in pregnancy for the treatment of spontaneous preterm labour and hypertension: a systematic review and meta-regression analysis. The Journal of Maternal-Fetal & Neonatal Medicine. Vol 23 (9): 1030-8.

24. Khosravi, S., Dabiran, S., Lotfi, M., et al., 2014. Study of the prevalence of hypertension and complications of hypertensive disorders in pregnancy. Open Journal of Preventive Medicine. Vol 4: 860-7.

25. Leeman, L., Dresang, L.T., and Fontaine, P., 2016. Hypertensive disorder of pregnancy. American Family Physicians. Vol 93 (2): 121-7.

26. Leslie, D. and Collins, R.E., 2016. Hypertension in pregnancy. BJA Education. Vol 16 (1): 33-7. https://doi.org/10.1093/bjaceaccp/mkv020.

27. Lovell, A.R., and Ernst, M.E., 2017. Drug-Induced Hypertension: Focus on Mechanisms and Management. Curr Hypertens Rep. Vol 19 (5): 39.

28. Lowe, S.A., Bowyer, L., Lust, K., et al., 2014. The SOMANZ guideline for the management of hypertensive disorders of pregnancy. SOMANZ.

29. Magee LA, von Dadelszen P, Singer J, Lee T, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez J, Gafni A, Gruslin A, Helewa M, Hutton E, Koren G, Lee SK, Logan AG, Ganzevoort JW, Welch R, Thornton JG, Moutquin J-M. Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial. BJOG 2016;123:1143–1151.

30. Malha, L., Podymow, T., August, P., et al., 2018. Hypertension in Pregnancy in Hypertension: A Companion to Braunwald's Heart Disease (Third Edition) Ch 39. Elsevier.

31. Matthews, G., Gornall., R., Saunders, N., 1997. A randomised placebo controlled trial of loop diuretics in moderate/severe pre-eclampsia, following delivery. Journal of Obstetrics and Gynaecology: The Journal of the Institute of Obstetrics and Gynaecology. Vol 17 (1): 30-2. https://doi.org/10.1080/01443619750114040.

32. Mudjari, N.S., and Samsu, N., 2015. Management of hypertension in pregnancy. Acta Med Indones-Indones J Intern Med. Vol 47 (1): 78-86.

33. Mustafa, R., Ahmed, S., Gupta, A., et al., 2012. A comprehensive review of hypertension in pregnancy. Journal of Pregnancy. Vol 2012.

34. Nadar, S., 2015. Pathophysiology of hypertension in Oxford Cardiology Library Hypertension 2nd Edition Ch 2. Oxford University Press.

35. National Institute for Health and Clinical Excellence (NICE), 2011. Hypertension in pregnancy: the management of hypertensive disorder during pregnancy. Royal College of Obstetricians and Gynaecologists. London.

36. O'Donnell, A., McParlin, C., Robson, Sc., et al., 2016. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. Health Technology Assessment. Vol 20 (74).

37. Ogura et al., 2019. Antihypertensive drug therapy for women with non-severe hypertensive disorders of pregnancy: a systematic review and meta-analysis. Hypertension Research. https://doi.org/10.1038/s41440-018-0188-0.

38. Olson-Chen, C., and Seligman, N.S., 2016. Hypertensive Emergencies in Pregnancy. Critical Care Clinics. Vol 32 (1): 29-41. https://doi.org/10.1016/j.ccc.2015.08.006.

39. Patel, P., Koli, D., Maitra, N., et al., 2018. Comparison of Efficacy and Safety of Intravenous Labetalol Versus Hydralazine for Management of Severe Hypertension in Pregnancy. J Obstet Gynaecol India. Vol 68 (5): 376-81. https://doi.org/10.1007/s13224-017-1053-9.

40. Regitz-Zagrosek, V., 2018. ‘Ten Commandments’ of the 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. Vol 39 (35): 3269. https://doi.org/10.1093/eurheartj/ehy478

41. Roberts, J.M., August, P.A., Bakris, G., et al., 2013. Hypertension in Pregnancy. American College of Obstetricians and Gynecologist. Washington DC.

42. Rothenberger, S., Carr, D., Brateng, D., et al., 2010. Pharmacodynamics of Clonidine Therapy in Pregnancy: a Heterogeneous Maternal Response Impacts Fetal Growth. American journal of hypertension. Vol 23 (11): 1234-40. https://doi.org/10.1038/ajh.2010.159.

43. Seely, E.W., and Ecker, J., 2014. Chronic hypertension in pregnancy. Circulation. Vol 129: 1254-61.

44. Sharma, C., Soni, A., Gupta, A., 2017. Hydralazine vs nifedipine for acute hypertensive emergency in pregnancy: a randomized controlled trial. American Journal of Obstetrics & Gynecology. Vol 217 (6): 687.e1-687.e6. https://doi.org/10.1016/j.ajog.2017.08.018.

45. Sibai, B.M., and Chames, M.C., 2008. Chronic hypertension in pregnancy. Glob. Libr. Women's Med. http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=156.

46. Siregar, T.G.M., 2003. Hipertensi esensial in: Rilantono dkk (ed). Buku Ajar Kardiologi. FKUI. Jakarta.

47. Suhardjono, 2017. Hipertensi sekunder in: Taruna, Y. and Widyantoro, B. Buku Ajar Hipertensi. Perhimpunan Dokter Hipertensi Indonesia. Jakarta.

48. Sutters, M., 2017. Systemic hypertension, in McPhee, S., Papadakis, M.A.(eds). Current Medical Diagnosis and Treatment. McGrawHill Lange. New York. P: 439-71.

49. Tranquilli, A.L., Dekker, G., Magee, L., et al., 2014. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the isshp. Pregnancy Hypertension: An international Journal of Women’s Cardiovaskular Health. Vol 4 (2): 97-104.

50. Vidal S.M., Schneck, M.J., Flaster, M.S., et al., 2011. Stroke- and pregnancy-induced hypertensive sindromes. Women’s Health. Vol 7 (3): 283-92.

51. Ward, K. and Lindheimer, M.D., 2009. Genetic factors in the etiology of pre-eklampsia/eklampsia in: Taylor, R.N., Robert, J.M., Cunningham, F.G., et al., Chesley’s Hypertensive Disorder in Pregnancy Ch. 4, 4th ed. Elsevier Inc. Cambridge.

52. Webster, L.M., Myers, J.E., Nelson-Piercy, C., et al., 2017. Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy. Hypertension. Vol 70 (5): 915-22. https://doi.org/10.1161/HYPERTENSIONAHA.117.09972.

53. Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., et al., 2017. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017. https://doi.org/10.1161/HYP.0000000000000065.

54. Whelton P.K., Appel L.J., Espeland M.A., et al., 1998. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. Vol 279: 839-46.

55. Whelton P.K., 2015. The elusiveness of population-wide high blood pressure control. Annu Rev Public Health. Vol 36:109-30.

56. Wiener, C., Kasper, D.L., Fauci, A.S., et al., 2017. Harrison's Principles of Internal Medicine Self-Assessment and Board Review, 19th Edition. McGraw-Hill Education/Medical. ISBN 978-1-259-64288-3.

57. Williams, B., Mancia, G., Spiering, W., et al., 2018. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. Vol 39 (33): 3021-104. https://doi.org/10.1093/eurheartj/ehy339.

58. World Health Organization (WHO), 2013. A Global Brief on Hypertension. World Health Day 2013.


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DOI: 10.30595/hmj.v2i2.4169

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