{"id":"af897d7f3e4f","type":"article","url":"https://hartvaat.nl/2026/03/20/bloeddrukverlaging-corrigeert-de-gestoorde-maternale-hemodynamiek-bij-pre-eclamp/","title":"Bloeddrukverlaging corrigeert de gestoorde maternale hemodynamiek bij pre-eclampsie niet","title_en":"Effects of Antihypertensive Therapy on Pre- and Postnatal Maternal Hemodynamics","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","laminopathie","peripartum-cardiomyopathie","vrouwen","zwangerschap-hart"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26126","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26126","authors":["Julia Binder"],"significance":6,"published":"2026-03-20","source_date":"2026-03-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"Hypertensive disorders of pregnancy (HDP) involve cardiovascular impairment reflected in an abnormal maternal haemodynamic profile, yet treatment targets blood pressure, not that profile. In this multicentre prospective case-control study (238 women: 69 gestational hypertension, 63 preeclampsia, 106 controls), haemodynamic parameters (cardiac output, stroke volume, systemic vascular resistance, inotropy) were measured before and after α-methyldopa and postnatally, complemented by a preeclamptic rat model. In gestational hypertension, treatment improved cardiac output and lowered vascular resistance, but in preeclampsia no significant haemodynamic changes occurred: vascular resistance remained elevated and stroke volume reduced up to one year postpartum. The rat model showed the same. Blood-pressure lowering thus does not correct the cardiovascular impairment in preeclampsia — novel strategies are needed for maternal heart health after HDP.","created":"2026-07-03T10:32:22Z","updated":"2026-07-03T18:39:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Hypertensieve zwangerschapsaandoeningen (HDP) gaan gepaard met cardiovasculaire beschadiging, zichtbaar in een afwijkend maternaal hemodynamisch profiel; de behandeling richt zich echter op de bloeddruk, niet op dat profiel. In deze multicentrische prospectieve case-controlstudie (238 vrouwen: 69 met zwangerschapshypertensie, 63 met pre-eclampsie, 106 controles) werden hemodynamische parameters (hartminuutvolume, slagvolume, systemische vaatweerstand, inotropie) gemeten vóór en na behandeling met α-methyldopa en postnataal, aangevuld met een pre-eclampsie-rattenmodel. Bij zwangerschapshypertensie verbeterde de behandeling het hartminuutvolume en verlaagde de vaatweerstand, maar bij pre-eclampsie traden geen significante hemodynamische veranderingen op: de vaatweerstand bleef verhoogd en het slagvolume verlaagd tot een jaar postpartum. Het rattenmodel toonde hetzelfde. Bloeddrukverlaging corrigeert de cardiovasculaire beschadiging bij pre-eclampsie dus niet — er zijn nieuwe behandelstrategieën nodig voor de maternale hartgezondheid na een HDP.","abstract_original":"Hypertension, Volume 83, Issue 6, Page e26126, June 1, 2026. BACKGROUND:Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular impairment reflected by abnormal maternal hemodynamics. Current treatment strategies target blood pressure rather than the maternal hemodynamic profile. Therefore, this study evaluated the effects of antihypertensive treatment on cardiovascular parameters in women with HDP, healthy pregnant women, and in a preeclamptic rat model.METHODS:This multicenter, prospective translational case-control study was conducted at the Medical University of Vienna and the Max Delbruck Center for Molecular Medicine, Berlin, between July 2019 and July 2024. Cardiovascular parameters including cardiac output, stroke volume, systemic vascular resistance, and inotropy index were measured pre- and posttreatment with α-methyldopa as well as postnatally using the USCOM 1A Monitor. In the rat model, the effects of α-methyldopa, nifedipine, and labetalol were evaluated.RESULTS:A total of 238 women were included: 132 with HDP (69 gestational hypertension, 63 preeclampsia) and 106 controls. In gestational hypertension, treatment led to increased cardiac output (median, 0.38 L/min [95% CI, 0.06–0.71];P=0.021) and a decrease in systemic vascular resistance (median, −0.08 log dynes/s per cm−5[95% CI, −0.14 to −0.03];P=0.005). In preeclampsia, no significant hemodynamic changes were observed. Systemic vascular resistance remained elevated and stroke volume index reduced in both HDP groups up to 1-year postpartum. Similar patterns were observed in the preeclamptic rat model, with persistently increased vascular resistance and reduced cardiac output and stroke volume.CONCLUSIONS:Antihypertensive therapy does not influence cardiovascular impairment despite lowering blood pressure in preeclampsia. Novel therapeutic approaches are needed to improve maternal cardiovascular health after HDP."}