HEALTH OF WOMAN. 2018.2(128):69–73; doi 10.15574/HW.2018.128.69

Humenna I. Ye. , Heryak S. M. , Shved M. I.
I. Horbachevsky Ternopil State Medical University of the Ministry of health of Ukraine

One of the leading mechanisms of the development of arterial hypertension (AH) and the formation of its complications is the disruption of the functioning of the vascular endothelium. Insufficient control of blood pressure (BP) in pregnant women and progression of symptoms of AH are accompanied by activation of lipid peroxidation (LPO) and a decrease in the activity of the antioxidant defense system, the increase in endothelial dysfunction.
The objective: was to increase the effectiveness of antihypertensive treatment in pregnant women with chronic hypertension by adequate correction of lipid peroxidation activity and disturbances in the functional state of the vascular endothelium.
Materials and methods. 64 pregnant women with chronic hypertension A, II stage and 2nd degree of severity, who were in the department of extragenital pathology on inpatient treatment in the Ternopil regional perinatal center «Mother and Child» in 2015-2017 were examined.
All pregnant women with diagnosed chronic AH in I, II, III trimesters received preventive doses of acetylsalicylic acid (75 mg / day).
Pregnant Group I (22 women), starting from the 20th week of pregnancy, was prescribed basic antihypertensive therapy to stabilize blood pressure, which included dopegit 250 mg 4 times a day. Patients of group II (21 women) additionally from the 30th week were assigned nebivolol hydrochloride at a dose of 5 mg per day as a highly selective beta-blocker of the third generation with vasodilativnym properties and the ability to modulate the synthesis of NO endothelium of the vessels. In the control group (ІІІ), 21 pregnant women – conditionally healthy women with singleton pregnancy and without somatic pathology, comparable in age and duration of pregnancy with patients of groups I and II – entered the control group (ІІІ).
Results. Basic treatment contributes to lowering blood pressure and improving clinical parameters in pregnant and fetus, but does not normalize LPO systems, antioxidant defense and endothelial function, and therefore does not prevent the development of hemodynamic complications in pregnant women and fetuses. Inclusion of a highly selective beta-blocker with vasodilating properties into the complex treatment due to modulation of the synthesis of nitric oxide nitrogen nebivolol hydrochloride helps reduce the activity of LPO, increase the protective ability of enzymes of the antioxidant system, which ultimately leads to normalization of blood pressure and prevention of hemodynamic disorders in the pregnant and fetus.
Conclusion. 1. Arterial hypertension (AH) in pregnant women is accompanied by progressive dysfunction of the vascular endothelium, which causes a significant imbalance in the functioning of the prooxidant-antioxidant defense system: the level of lipid peroxidation (LPO) increased against the background of a decrease in the activity of antioxidant defense enzymes.
2. Inclusion of a highly selective beta-blocker with vasodilative properties in the basic therapy of pregnant women with AH promotes a decrease in lipid peroxidation activity, an increase in antioxidant protection, is accompanied by restoration of vascular endothelial function and normalization of blood pressure and hemodynamics in the mother-placenta-fetus system. This is reliably demonstrated by the normalization of the biophysical profile of the fetus and the evaluation of the CTG of the fetus according to the Fisher scale.
Key words: pregnancy, arterial hypertension, endothelial dysfunction, lipids peroxidation, antioxidant system, treatment.

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