Hemodynamics-guided therapy for hypertensive disorders of pregnancy: a systematic review

OBJECTIVE: Despite on-going research into the underlying pathology of hypertensive disorders in pregnancy, maternal mortality is hardly decreasing. Current antihypertensive therapy is aimed at controlling symptoms and preventing severe courses of pregnancy. Traditional management focuses on blood pressure (BP) control, but does not consider individual hemodynamic variations. Hemodynamically guided therapy offers a personalized approach that can improve BP control and outcomes by treating the underlying pathophysiology. The aim of this review is to provide an overview of hemodynamically guided antihypertensive therapy in hypertensive disorders of pregnancy and to present the results of recent intervention trials in this area. METHODS: Literature searches were conducted in the electronic databases PubMed, CENTRAL, and Google scholar from inception to May 2024 for studies that used maternal hemodynamic parameters like cardiac output (CO) or TPVR (total peripheral vascular resistance) to guide antihypertensive therapy in pregnant women with hypertensive disorders or at elevated risk for developing preeclampsia. The review included intervention studies. RESULTS: A total of five studies met the inclusion criteria. All studies showed improved BP control when the antihypertensive medication administered was matched to hemodynamic characteristics of the women being treated. Using a personalized approach, pregnancy complications were significantly reduced in patients with both hypo- or hyperdynamic circulation, even in patients with a history of preeclampsia. CONCLUSION: The study shows that hemodynamically triggered antihypertensive therapy can improve outcomes for both mother and child in cases of hypertensive pregnancy disorders. However, further placebo-controlled studies are necessary before a final assessment of this therapy can be made.