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5. Effectiveness of Antihypertensive Drugs in the Treatment of Hypertension in Pregnancy

Author

Voto, Liliana, Quiroga, Carlos, Lapidus, Alicia, Catuzzi, Patricia, Imaz, Francisco Uranga, and Margulies, Miguel

Abstract

The purpose of this open, prospective, randomized, comparative study was to examine the effectiveness of atenolol, a cardioselective beta1 blocker, alphamethyldopa, an alpha-adrenergic antagonist, and ketanserin, a serotonin receptor antagonist, in the treatment of 90 patients (N-30 each) with severe chronic hypertension (ChH) during pregnancy or severe pregnancy-induced hypertension, with or without proteinuria in either case.Arterial blood pressure (BP) for each drug group was analyzed at the onset of treatment, weekly for three weeks, and at the end of pregnancy. After one week of treatment a significant drop in BP was observed in the three groups of patients. Thereafter BP remained stable until the end of gestation, when a slight increase in BP was observed, especially in the group of patients treated with ketanserin.No significant difference was observed between the groups in mean birthweight and perinatal morbidity and mortality. No adverse effects from the drugs on the fetus or newborn were observed. No significant difference was observed among the three drugs in their antihypertensive effect. However, given the relatively small numbers of patients studied, definitive statements regarding the relative efficacy and safety of alphamethyldopa, ketanserin and atenolol cannot be made. Thus, additional, larger controlled trials of these agents are required.

Published
1990
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9. [Hormonal replacement therapy. Benefits and risks].

Author

Lapidus AM

Subjects
Aged, Female, Humans, Middle Aged, Osteoporosis prevention & control, Risk Factors, Hormone Replacement Therapy, Menopause physiology
Abstract

Unlabelled: A woman lives an average of between 25 to 30 years since the beginning of menopause. This period of life is characterized for the appearance of chronic diseases. Estrogens are effective in controlling vasomotor symptoms and also over the loss of bone mineral density, therefore lowering the risk of fractures in about 25-30%. The use of unopposed estrogens (without progesterone) raises 8 to 10 times the risk of endometrial and 2 to 3 times the risk of deep venous thrombosis as well. Until now, no raise was seen in breast cancer in short treatments (less than 5 years) especially if they are not opposed with progesterone. The recent publication of the surprising data of the trial Women's Health Initiative demonstrates a significative but small increase in the risk of breast cancer associated with the use of combined estrogen/progestin therapy proportional to the duration of the treatment. The reduction of the plasmatic levels of low density lipoproteins associated with the use of Hormonal Replacement Therapy (HRT), has not been linked to evident cardiovascular protection. There is a higher cardiovascular risk with the use of HRT in the first year of the treatment. No clear benefit of HRT has been associated to treatment of Alzheimer disease, and is still under investigation its role in the prevention of the disease., Conclusions: 1) A careful analysis of advantages and risks of HRT must be done before its use. 2) The treatment must be instituted on an individual basis and should be discussed with each patient.

Published
2002

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