Renata CífkováCharles University , Czech Republic
Title: Drug treatment of hypertension in pregnancy
Hypertensive disorders in pregnancy (HDP) are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality. There is a consensus that SBP ≥170 or DBP ≥110 mmHg is an emergency and hospitalization is indicated. Hospitalization is also mandatory for severe hypertension, defined as BP ≥ 160/110 mmHg. The selection of the antihypertensive drug and its route of administration depend on the expected time of delivery, and on the presence or absence of pre-eclampsia. The results of the CHIPS and CHAP studies reduced the threshold for initiating treatment for mild hypertension, prompting the 2023 European Society of Hypertension guidelines to recommend initiating drug treatment in pregnant women with persistent elevation of BP ≥ 140/90 mmHg. Methyldopa, labetalol, and calcium antagonists (the most data are available for nifedipine extended release) are the drugs of choice. Because of the risk of fetal hypoperfusion, aggressive BP lowering is not recommended and DBP ˂ 80 mmHg should be avoided. A low dose of aspirin (100-150 mg at bedtime) should be administered to women at high or moderate risk of pre-eclampsia from weeks 11-14 until 36 weeks of gestation. Women with a history of HDP, particularly those with pre-eclampsia, are at high risk of developing cardiovascular disease later in life. Obstetric history should become a part of the cardiovascular risk assessment in women.
Renata Cifkova completed her medical education at Charles University, Prague and in 1986 earned a PhD in internal medicine with emphasis on cardiology. In 1992, Dr. Cifkova was appointed Head, Department of Preventive Cardiology, Institute for Clinical Experimental Medicine, Prague, Czech Republic. She also has a part-time appointment with the Charles University Medical School in Prague (Professor of Medicine). She was a Postdoctoral Fellow at the Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada. Her main research interests are epidemiology of cardiovascular risk factors, primary and secondary prevention of cardiovascular disease, and related clinical trials. For her outstanding contribution to research, education, and leadership in the fields of hypertension and cardiovascular protection, Prof. Cifkova was conferred the Peter Sleight Award by the European Society of Hypertension in 2009. Her research was acknowledged by the Czech Ministry of Health (2010,2015). She has about 300 publications in journals with an impact factor