ANTIHYPERTENSIVES THERAPY AND MONITORING IN PRE-ECLAMPSIA: ROLE OF THE PHARMACIST
Main Article Content
Keywords
antihypertensives in pre-eclampsia, obstetrics, hypertension in pregnancy, monitoring, pharmacists’ role
Abstract
Pre-eclampsia is an obstetric disorder that affects the prognosis of pregnancy, resulting in complications or mortalities. It is typically associated with hypertension which should be managed pharmacologically to protect the health of the mother and the fetus. Yet, not much is known about pharmacists’ roles and commitment to pre-eclampsia management. In this review, we update pharmacists on antihypertensives indicated in pre-eclampsia as well as parameters they have to monitor during pharmacotherapy in line with their duty of care to women with pre-eclampsia. Using recent evidence from 16 national/international guidelines (2014-2022), we compared antihypertensives approved for use in pregnancy and highlighted major drug information that pharmacists require to optimize the use of these medications in pre-eclampsia. Intravenous labetalol, hydralazine or oral nifedipine agents are mostly indicated in pre-eclampsia with severe hypertension. In mild-moderate hypertension, oral agents such as methyldopa, labetalol, sustained released nifedipine and hydralazine are the commonest recommendations. While monitoring for maternal bronchoconstriction, neonatal bradycardia or hypoglycemia is required with the administration of intravenous labetalol; intravenous hydralazine is observed for maternal shock; nifedipine for tachycardia, headache, ankle edema and methyldopa for depression if use is extended to the postpartum period. Controlled hypertension in pre-eclampsia mitigates maternal vascular complications. Apart from early referral and counselling of pregnant women at risk, pharmacists with sound knowledge of the pharmacotherapy of pre-eclampsia could advise on appropriate antihypertensive therapy and follow on to ensure that these medicines are responsibly used for optimal outcomes. These roles by pharmacists, may reduce adverse maternal outcomes associated with pre-eclampsia.
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15. Annan GN, Asiedu Y. Predictors of neonatal deaths in Ashanti Region of Ghana: A cross-sectional study. Adv Public Health 2018; Article ID 9020914.https://doi.org/10.1155/2018/9020914
16. Roy S, Sultana K, Hossain S, et al. Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh. BMC Health Serv Res 2020; 20(1):838. https://doi.org/10.1186/s12913-020-05685-6
17. Kirk KR, Dempsey A. A systematic review of the treatment and management of pre-eclampsia and eclampsia in Bangladesh. Washington DC: Population Council 2017. https://doi.org/10.31899/rh7.1000.
18. Kattah AG, Garovic VD. The management of hypertension in pregnancy. Adv Chronic kidney Dis 2013; 20(3):229-39.https://doi.org/10.1053/j.ackd.2013.01.014.
19. Shamsi U, Saleem S, Nishtar N. Epidemiology and risk factors of pre-eclampsia; an overview of observational studies. Almeen J Med Sci 2013; 6(4): 292-300. Available at: http://ajms.alameenmedical.org/ArticlePDFs/AJMS%20V6.N4.2013%20p%20292-300.pdf
20. Republic of Ghana, Ministry of Health Standard Treatment Guidelines. 7 ed. Ghana Yamens Press Ltd, 2017. Available at: https://www.moh.gov.gh/wp-content/uploads/2020/07/GHANA-STG-2017-1.pdf
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22. Rabi DM, Kerry A, McBrien KA, et al. Hypertension Canada’s 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J of Cardiol 2020; 36(5):596-624. https://doi.org/10.1016/j.cjca.2020.02.086.
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28. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. ESC Scientific Document Group, 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur heart J 2018;39(34):3165-241.https://doi.org/10.1093/eurheartj/ehy340.
29. Lowe SA, Bowyer L, Lust K, et al. SOMANZ guidelines for the management of hypertensive disorders of pregnancy. Aust N Z J ObstetGynecol2015; 55(5): e1–e29.https://doi.org/10.1111/ajo.12399.
30. Tykarski A, Narkiewicz K, Gaciong Z, et al. 2015 guidelines for the management of hypertension. Recommendations of the Polish Society of Hypertension—short version. Kardiol Pol 2015;73(8):676-700. https://doi.org/10.5603/KP.2015.0157.
31. Kim KI, Ihm SH, Kim GH, et al. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin hypertens 2019; 25(19). https://doi.org/10.1186/s40885-019-0123-y
32. Gillon TE, Pels A, von Dadelszen P, et al. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One 2014;9(12):e113715.https://doi.org/10.1371/journal.pone.0113715.
33. Garovic, VD, Dechend R, Easterling T, et al. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension 2022. 79(2):e21-e41. https://doi.org 10.1161/HYP.0000000000000208
34. Awaludin A, Rahayu C, Daud NAA, Zakiyah N. Antihypertensive medications for severe hypertension in pregnancy: A Systematic Review and Meta-Analysis. In Healthcare (Basel) 2022;10(2):325. https://doi.org/10.3390/healthcare10020325
35. Barroso WKS, Rodrigues CIS, Bortolotto LA, et al. Brazilian guidelines of hypertension–2020. Arq Bras Cardiol 2021; 116(3):516-658.https://doi.org/10.36660/abc.20201238
36. Hart TD, Harris BM. Pre-eclampsia revisited. US Pharmacist 2012;37(9):48-53. https://www.uspharmacist.com/article/preeclampsia-revisited
37. Aali, SB, Nejad SS. Nifedipine or hydralazine as a first-line agent to control hypertension in severe pre-eclampsia. Acta Obstet Gynecol Scand 2002; 81(1): 25-30.https://doi.org/10.1034/j.1600-0412.2002.810105.x.
38. Ibrahim MM. Egyptian hypertension guidelines. Egypt Heart J 2014; 66(2):79-132. Available athttps://scholar.cu.edu.eg/?q=ghadayoussef/files/egyptian_htn_guidelines_publication.pdf
39. Biola A, Givertz MM, Colucci WC. Inotropic and vasoactive agents in cardiac intensive care. Brown DL (editors). 3 ed. Elsevier, 2019:394-401.e3. https://doi.org/10.1016/B978-0-323-52993-8.00037-0
40. Aronson JK. Labetalol. Meyler's side effects of drugs. 16 ed. UK, Elsevier, 2016:439-440. https://doi.org/10.1016/B978-0-444-53717-1.00951-3
41. Christof S, Paul P, Richard KM. Drugs during pregnancy and lactation. Treatment options and risk assessment. 3 ed. UK, Elsevier. 2015. Available at https://rudiapt.files.wordpress.com/2017/11/drugs-during-pregnancy-and-lactation-3rd-ed-2015.pdf
42. Maclean AB, Doig JR, Aickin DR. Hypovolemia, pre-eclampsia and diuretics. Br J Obstet Gynecol 1978; 85(8):597-601.https://doi.org/10.1111/j.1471-0528.1978.tb14927.x.
43. Medsafe, ACE Inhibitors in early pregnancy. 1998. Available at https://medsafe.govt.nz/profs/puarticles/aceinhibitors.htm (accessed on: October 29, 2022).
44. American Pharmacists Association. Lexicom drug information handbook. 25 ed. USA, Wolters Kluwer, 2016.
45. Miller M, Kerndt C, Maani CV. Labetalol. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534787/ (assessed on Sept 10, 2022)
46. Khatri R, Fallon JK, Sykes C, et al. Pregnancy-related hormones increase UGT1A1-mediated labetalol metabolism in human hepatocytes. Front Pharmacol 2021;12:655320. https://doi.org/10.3389/fphar.2021.655320.
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Jul 19, 2023
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Francis Fordjour, Edward Tieru Dassah, Kofi Boama Mensah, Adu Appiah-Kubi, Patrick Amoateng, Boabeng Kwame Ohene, & Darko Kwadwo Addae. (2023). ANTIHYPERTENSIVES THERAPY AND MONITORING IN PRE-ECLAMPSIA: ROLE OF THE PHARMACIST. Journal of Population Therapeutics and Clinical Pharmacology, 30(17), 354–367. https://doi.org/10.53555/jptcp.v30i17.1452
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Author Biographies
Francis Fordjour
Department of Pharmaceutical Sciences, Sunyani Technical University, P. O. Box 206, Sunyani, Ghana
Edward Tieru Dassah
Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
Kofi Boama Mensah
Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
Adu Appiah-Kubi
Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
Patrick Amoateng
Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Legon, Accra
Boabeng Kwame Ohene
Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
Darko Kwadwo Addae
Department of Obstetrics and Gynaecology, Bono Regional Hospital, P. O. Box 27, Sunyani, Ghana