Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis

Figures & data

Figure 1. Patient selection chart.

Table 1. Sociodemographic characteristics according to the presence of resistant hypertension in women with severe preeclampsia hospitalized between 2018 and 2019.

Variable	Total N = 57	Nonresistant Hypertension N = 23	Resistant Hypertension N = 34	p-value
Maternal age, years	27.00 (22.00–31.00)	26.00 (22.00–3.00)	29.00 (22.00–34.00)	0.28
≥35 years	7 (12.28%)	0 (.00%)	7 (2.59%)	0.034
21–30 years	22 (38.60%)	6 (26.09%)	16 (47.06%)	0.11
19–20 years	7 (12.28%)	1 (4.35%)	6 (17.65%)	0.22
≤18 years	4 (7.02%)	1 (4.35%)	3 (8.82%)	0.64
Gestational age at admission, weeks	32.10 (28.60–36.00)	36.00 (33.10–37.50)	29.35 (28.00–33.20)	<0.001
Gestational age at admission <34 weeks	32 (56.14%)	6 (26.09%)	26 (76.47%)	<0.001
Nulliparity	24 (42.11%)	10 (43.48%)	14 (41.18%)	0.86
BMI	30.10 (26.30–32.90)	3.00 (25.71–32.50)	31.00 (26.30–33.60)	0.81
BMI ≥25	46 (80.70%)	19 (82.61%)	27 (79.41%)	0.76
BMI ≥30	30 (52.63%)	12 (52.17%)	18 (52.94%)	0.95
BMI ≥35	9 (15.79%)	4 (17.39%)	5 (14.71%)	0.79
Rural area of residence	11 (19.30%)	3 (13.04%)	8 (23.53%)	0.33
Subsidized Social Security health system	30 (52.63%)	14 (6.87%)	16 (47.06%)	0.31
Education level (n = 55)				0.11
None	1 (1.75%)	0 (.00%)	1 (2.94%)
Elementary school	8 (14.04%)	1 (4.35%)	7 (2.59%)
High school	21 (36.84%)	11 (47.83%)	10 (29.41%)
Technician/Technologist	18 (31.58%)	6 (26.09%)	12 (35.29%)
Bachelor degree	7 (12.28%)	5 (21.74%)	2 (5.88%)
Ethnicity, n(%) (n = 49)				0.83
Mestizo	44 (77.19%)	18 (78.26%)	26 (76.47%)
Black, n(%)	4 (7.02%)	2 (8.70%)	2 (5.88%)
Indigenous, n(%)	1 (1.75%)	0 (.00%)	1 (2.94%)

Data are presented as median (RIC) for continuous measures and n (%) for categorical measures. BMI: body mass index.

Figure 2. Scatter plot distribution among patients with resistant and nonresistant postpartum hypertension.

Table 2. Hemodynamic parameters according to the presence of resistant hypertension in women with severe preeclampsia at hospital admission from 2018 to 2019.

Variable	Total N = 57	Nonresistant Hypertension N = 23	Resistant Hypertension N = 34	p-value
Systolic blood pressure, mmHg	165.00 (161.00–174.00)	163.00 (16.00–169.00)	168.00 (162.00–18.00)	0.005
Diastolic blood pressure, mmHg	101.00 (97.00–110.00)	105.00 (97.00–11.00)	101.00 (96.00–11.00)	0.55
Cardiac output at admission, L/min	5.90 (4.60–7.40)	6.50 (5.70–8.20)	5.70 (4.20–7.10)	0.028
Cardiac output index at admission, L/min/m^2	3.40 (2.70–4.00)	3.70 (3.20–4.30)	3.10 (2.40–3.80)	0.007
Stroke volume at admission, mL	65.30 (53.60–83.30)	67.20 (59.40–84.50)	63.55 (47.30–79.60)	0.15
Stroke volume variability at admission, %	14.00 (11.00–17.00)	13.00 (1.00–15.00)	16.00 (12.00–17.00)	0.029
Stroke volume index at admission, ml/m^2	37.00 (31.00–48.00)	37.00 (33.00–49.00)	37.50 (28.00–44.00)	0.20
Total peripheral resistance at admission, dyn·s/cm5	1423.00 (1216.00–1727.00)	1364.00 (115.00–15.00)	1489.00 (1295.00–2026.00)	0.032
Total peripheral resistance index at admission, dyn·s/cm5/m^2	2516.00 (2222.00–3095.00)	2309.00 (2034.00–2635.00)	2722.50 (2317.00–3336.00)	0.014
Cardiac output ≤5 L/min	16 (28.07%)	2 (8.70%)	14 (41.18%)	0.007
Cardiac output ≥8 L/min	41 (71.93%)	21 (91.30%)	20 (58.82%)	0.007
Total peripheral resistance ≥ 1400 dyn·s/cm5	31 (54.39%)	9 (39.13%)	22 (64.71%)	0.057
Total peripheral resistance ≤ 900 dyn·s/cm5	1 (1.75%)	1 (4.35%)	0 (.00%)	0.40

Data are presented as median (RIC) for continuous variables and n (%) for categorical variables.

Table 3. Maternal complications according to the presence of resistant hypertension in women with severe preeclampsia hospitalized between 2018 and 2019.

Variable	Total N = 57	Nonresistant Hypertension N = 23	Resistant Hypertension N = 34	p-value
Uncontrolled hypertensive crisis	24 (42.11%)	11 (47.83%)	13 (38.24%)	0.47
Nitroprusside requirement*	16 (29.63%)	4 (18.18%)	12 (37.50%)	0.13
Admission to the maternal ICU*	43 (79.63%)	11 (5.00%)	32 (1.00%)	<0.001
Acute Pulmonary Edema*	6 (11.11%)	1 (4.55%)	5 (15.62%)	0.20
Acute Kidney Failure	6 (10.53%)	1 (4.35%)	5 (14.71%)	0.21
HELLP Syndrome	5 (8.77%)	1 (4.35%)	4 (11.76%)	0.33
Eclampsia	5 (8.77%)	0 (.00%)	5 (14.71%)	0.054
Sepsis*	1 (1.85%)	1 (4.55%)	0 (.00%)	0.22
Severe Obstetric Haemorrhage	7 (12.28%)	0 (.00%)	7 (2.59%)	0.020
Cardiac dysfunction*	2 (3.70%)	0 (.00%)	2 (6.25%)	0.23
Vascular dysfunction*	41 (75.93%)	10 (45.45%)	31 (96.88%)	<0.001
Kidney dysfunction	4 (7.02%)	0 (.00%)	4 (11.76%)	0.088
Liver dysfunction	2 (3.51%)	1 (4.35%)	1 (2.94%)	0.78
Metabolic dysfunction	3 (5.26%)	1 (4.35%)	2 (5.88%)	0.80
Cerebral dysfunction	6 (10.53%)	1 (4.35%)	5 (14.71%)	0.21
Respiratory dysfunction*	2 (3.70%)	0 (.00%)	2 (6.25%)	0.23
Coagulation dysfunction	9 (15.79%)	5 (21.74%)	4 (11.76%)	0.31
Number of organ dysfunctions*	1.00 (1.00–2.00)	1.00 (.00–1.00)	1.00 (1.00–2.00)	<0.001
≥1 Organ dysfunction*	45 (83.33%)	14 (63.64%)	31 (96.88%)	0.001
MOD*	15 (27.78%)	2 (9.09%)	13 (4.62%)	0.011

Data are presented as median (RIC) for continuous variables and n (%) for categorical variables.

ICU: Intensive care unit; MOD: Multiple Organ Dysfunction; HELLP syndrome: Syndrome of hemolysis, elevated liver enzymes, and thrombocytopenia.

*Variables with n = 54 for three missing data.

There were no reported cases of acute heart failure, posterior reversible encephalopathy syndrome, Subcapsular Liver Hematoma, and maternal deaths.

Table 4. Neonatal complications according to the presence of resistant hypertension in women with severe preeclampsia and hospitalized between 2018 and 2019.

Variable	Total N = 57	Nonresistant Hypertension N = 23	Resistant Hypertension N = 34	p-value
Gestational age at the end of pregnancy, weeks	32.70 (28.30–36.10)	35.75 (33.10–37.60)	29.75 (28.00–33.10)	<0.001
Birth weight, gms	1638.50 (1100.00–2630.00)	2259.00 (1649.00–283.00)	1246.00 (859.50–2097.00)	0.001
Low birth weight (<2500 gms)*	39 (72.22%)	12 (54.55%)	27 (84.38%)	0.016
APGAR 1 min, value	7.00 (3.00–8.00)	8.00 (7.00–8.00)	5.00 (2.00–6.00)	<0.001
APGAR 5 min, value	8.00 (6.00–9.00)	9.00 (8.00–9.00)	7.00 (4.00–8.00)	<0.001
APGAR 5 min < 7	16 (28.07%)	1 (4.35%)	15 (44.12%)	0.001
Intrauterine growth restriction, n(%)	8 (14.04%)	6 (26.09%)	2 (5.88%)	0.051
Neonatal death, n(%)*	7 (12.96%)	1 (4.55%)	6 (18.75%)	0.22
NICU admission, n(%)*	34 (62.96%)	9 (4.91%)	25 (78.12%)	0.005
Length of NICU stay	8.00 (0.00–32.00)	0.00 (0.00–11.00)	2.00 (3.00–63.00)	0.002
Neonatal ARDS*	26 (48.15%)	8 (36.36%)	18 (56.25%)	0.15
Intraventricular hemorrhage of the newborn*	7 (12.96%)	1 (4.55%)	6 (18.75%)	0.22
Neonatal necrotizing enterocolitis*	3 (5.56%)	0 (0.00%)	3 (9.38%)	0.26

Data are presented as median (RIC) for continuous variables and n (%) for categorical variables.

APGAR: Appearance, Pulse, Grimace, Activity, and Respiration; NICU: neonatal intensive care unit; ARDS: acute respiratory distress syndrome.

*Variables with n = 54 for three missing data.

Data availability statement

The data that support the findings of this study are available from the corresponding author (MFE), upon reasonable request.