Evaluating cardiovascular and blood pressure profiles throughout pregnancy and in response to medication in patients at high risk for or diagnosed with GHD: opportunities for improving patient-tailored therapy. (R-11278)

Adaptation of the maternal cardiovascular (CV) system to pregnancy occurs in the first weeks of gestation to supply fetal and placental oxygen and nutrients in a high-volume, low-resistance circulation. CV maladaptation underlies the etiology of gestational hypertensive disorders (GHD). Our research group already observed trimestral GHD-subtype specific CV differences. However, current management of GHD does not take these underlying subtype-specific CV maladaptations into account, but is solely focused on maintaining a safe maternal blood pressure (BP). Telemonitoring (TM), patient self-measurement, and usual care for this at-risk-population are compared in the PREMOM II study. The choice of antihypertensive agent is based on cardiac output-driven or chosen at random (current standard care). Although daily BP data is available in the TM group, the effect of medication on the total CV profile is not assessed. The CAPROM study, therefore, hypothesizes that subclinical subtype-specific CV changes are detected before (clinical) increase in BP and in response to medication. To this end, CV measurements are performed on women included in the TM group of the PREMOM II project. CV profiling is done monthly until delivery, right before the start/switch of medication upon high BP alarm registered via TM, and again one week later to evaluate the impact of the medication on the CV parameters. The CAPROM study is the first to evaluate the relationship between longitudinal (clinical) BP measurements and changes in (subclinical) CV hemodynamics throughout pregnancy, as well as their responses to different types of medication. Our results aim to improve innovative patient-tailored management strategy beneficial for both mother and child.

Keywords:Cardiovascular disease

Disciplines:Cardiac and vascular medicine not elsewhere classified, Obstetrics, Pathophysiology