Hypertension in pregnancy: unanswered questions

Background: Hypertension of pregnancy [office blood pressure (BP) levels≥140/90 mmHg] is fairly common and can affect up to 10% of pregnant women worldwide. Hypertension of pregnancy is an important risk factor for the mother and carries increased morbidity and mortality for the fetus. Women with hypertension of pregnancy have a high-risk for future cardiovascular and renal events. Objectives: To summarize the literature related to several clinical aspects of hypertension in pregnancy and draw clinically meaningful conclusions. Method: We conducted an in-depth review of the literature to retrieve existing data on the definition, epidemiology, classification, and management of hypertension in pregnancy. Results: All pregnant women with hypertension should have a proper diagnostic workup and be treated appropriately. In women with mild hypertension, BP therapeutic target should be set to 110-140/80-85mmHg. In women with severe hypertension, BP should be reduced by at least 25% as soon as possible, and gradually thereafter to normal target levels of <140/105mmHg. In terms of preeclampsia, physicians need to consider potential complications and formulate prevention strategies. The choice of antihypertensive medication is crucial since certain classes can be detrimental to the fetus and should be avoided. Post-partum, the choice of antihypertensive therapy of the mother should take into consideration breastfeeding of the fetus. Given the life-long cardiovascular risk of women with pregnancy hypertension, a regular cardiovascular evaluation is in order. Conclusion: Albeit the antihypertensive treatment exerts significant benefits for both the mother and the baby, several clinical aspects remain un-tackled. More research is needed to further improve the treatment of such disorders.

DESCRIPTION OF HYPERTENSION LEVELS IN PRIMARY HYPERTENSION ADULTS AND ELDERLY IN KARANGBINANGUN LAMONGAN DISTRICT

Introduction: Hypertension is often a silent killer because it is often without symptoms that warn of a problem. Symptoms that appear are often considered as common disorders, so that the victim is too late to realize that the disease is coming. Hypertension is an increase in blood pressure above normal limits with systolic value of 140 mmHg and diastolic value of 90 mmHg. The purpose of this study was to determine the level of hypertension in patients with primary hypertension in Karangbinangun Lamongan District. Method: This research design using descriptive with a population of 70 respondents then sampled using simple random sampling and get a sample of 64 respondents, in accordance with the inclusion criteria, are healthy patients and willing to sign the informed consent The variable in this study is the level of hypertension. The data of this study were taken from the results of blood pressure measurements by standards WHO. The data is tabulated in the form of frequency distribution by categorizing hypertension into mild, moderate and severe. Result: The results showed that half of the respondents (50%) had mild hypertension, 28.1% moderate hypertension and 21.9% severe hypertension. Conclusion: Seeing the results of this study, that there are still many people who have hypertension, so health education by health workers and family is needed to prevent recurrence.

Pregnancy outcome in Takayasu arteritis

A young pregnant woman, G2P1L1, was admitted for safe confinement at 40 weeks of gestation with Takayasu arteritis. She was diagnosed with Takayasu arteritis in 2016 when she had polyarthritis, hypertension and asymmetrical peripheral pulses. Her CT angiogram showed involvement of branches of aortic arch and coeliac trunk. She had mild pulmonary hypertension and was classified as type V disease (P)+. She was started on immunosuppressant medication and achieved a fair control of symptoms and disease activity. She gave history of treatment for pulmonary tuberculosis for 6 months in 2016 after which she developed polyarthralgia. She is currently asymptomatic and had mild hypertension that was controlled. She was evaluated for evidence of aneurysms/thrombus/aortic insufficiency and taken up for elective caesarean in view of type V disease. Maternal and perinatal outcome was good and she was discharged on her regular medication as per immunology opinion.

BILIARY DISEASE IN PREGNANCY: A DIAGNOSTIC DILEMMA

This is a case report of a 37-year-old female who presented with deranged liver function tests, epigastric pain, fevers, vomiting, mild hypertension, and proteinuria in pregnancy. This was on a background of gestational diabetes, dyspepsia, and previous cholecystectomy. This case report highlights the importance of considering various causes of liver pathology during pregnancy besides those specifically associated with pregnancy, as well as the necessity of early specialist input to investigate symptomatic choledocholithiasis in pregnancy.

12 -week brisk-walking intervention on middle-aged mild-Hypertensive population in Asaba, Delta state, Nigeria.

Purpose: 12 week- brisk walking exercise intervention at 50%-70% intensity was carried out in the study to examine the mean reduction on systolic and diastolic blood pressures of middle-aged mild-hypertensive population in Asaba, Nigeria. Methodology: The study comprised of 42 male and female middle-aged (36-45years) individuals who recorded mild-hypertension. A control group-pre-test and post-test experimental design was used to randomly assign the individuals into treatment and control groups. Whereas, arithmetic mean and standard deviation were used to analyze the data according to the difference in mean scores. Conclusion: In conclusion, 12-week brisk walking intervention showed a mean reduction on systolic blood pressure (SBP) and diastolic blood pressure (DBP) of middle-aged mild-hypertensive population. Precisely, the experiment indicated that those who did not partake in the exercise intervention (control group) showed an increase on SBP and a decrease on DBP and thereby indicating a relatively higher mean reduction of 12-week brisk-walking exercise on SBP of middle-aged mild-hypertensive population. Recommendations: The study recommended that 50% -70% intensity of 12-week brisk-walking exercise may likely present a therapeutic intervention for people with mild-hypertension.

The use of epoetin alfa biosimilar in the anemia management in hemodialysis patients

The present study aimed to evaluate the efficacy and safety of EMAVAIL (epoetin alfa) in the correction of anemia in hemodialysis patients. Methods. A total of 36 patients undergoing regular hemodialysis were enrolled in this prospective study. Among the patients were 19 (53%) men and 17 (47%) women with severe anemia (hemoglobin (Hb) level ≤ 90 g/L). The mean patients' age was 48.41±1.82 years, an average dialysis vintage consisted of 42.38±10.41 months. All the patients had thrice-weekly hemodialysis sessions, with a mean duration of 12.6 ± 0.51 hours per week and Kt/V 1.27 ± 0.08. All the patients were treated with biosimilar of epoetin alfa EMAVAIL intravenously three times a week in adjustable doses. The follow-up period was 56 days. Results. At the study entry, the mean Hb level in hemodialysis patients was 81.7±0,93 g/L. In 56 days of anemia treatment, the concentration of Hb increased to 109.17±1.75 g/L. Eventually, 32 (89%) patients achieved the target Hb level (110 g/L); 6 (17%) patients had adverse events (mild hypertension). There were no serious adverse events. Conclusions. EMAVAIL is an effective and safe epoetin alfa biosimilar for anemia management in hemodialysis patients.