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New pharmacological treatments for hypertension during pregnancy

Abstract:

At present, pregnancy-induced hypertension (PIH) repre-sents one of the main obstacles for the reduction of mater-nofetal morbidity and mortality. Moreover, PIH is associated with numerous medical complications whose implications extend over the future development of the product of the pregnancy, such as low birth weight, restriction of intrauterine growth, and multiple perinatal problems; as well as a deterio-ration of general long-term maternal health. This prominence has highlighted the shortcomings of the current pharmaco-therapeutic arsenal for PIH, which often shows unsatisfactory levels of efficacy, or unacceptable adverse effects. Indeed, it is urgent to introduce new alternatives for the treatment of PIH, with the objective of improving maternal and fetal out-comes. Fortunately, this crisis has been developed in parallel with giant steps in the comprehension of the pathogeny of PIH, which opens the doors for a wide spectrum of newly identified interventional opportunities. In particular, the cen-tral role of alterations such as chronic inflammation, oxida-tive stress, and endothelial dysfunction has been key in this scenario. Pharmacological classes under study include calcium channel blockers, nitrogen donors, phosphodiesterase 5 inhibitors, soluble guanylate cyclase activators, endothelin, and thromboxane antagonists, prostacyclin agonists, and in-hibitors of Rho-kinase and xanthine oxidase. In this review, new proposals for the pharmacological treatment of PIH are discussed, with emphasis on new therapeutic targets.