PREGNANCY HYPERTENSIVE SYNDROME: UPDATE AND THERAPEUTIC PERSPECTIVES DIVISION

Abstract

Hypertensive Disorders of Pregnancy (HDP), particularly preeclampsia, represent the leading cause of direct maternal death worldwide and in Brazil, maintaining high morbidity and mortality rates. Given the continuous evolution of scientific knowledge, this Integrative Literature Review aimed to synthesize the latest pathophysiological, diagnostic, and therapeutic updates on HDP, focusing on publications and clinical guidelines from January 2020 onward. The methodology involved a systematic search in databases such as PubMed/MEDLINE, Embase, SciELO, and LILACS, in addition to guidelines from organizations such as FEBRASGO. The results demonstrate progress in the understanding of pathophysiology, now primarily centered on angiogenic imbalance, while exploring the role of new etiological factors such as intestinal microbiota dysbiosis and the impact of pro-inflammatory conditions. In diagnostics, there has been consolidation of criteria for target-organ dysfunction and the incorporation of angiogenic biomarkers to improve risk stratification and short-term prognosis, enhancing clinical decision-making. Acute management reinforces the effectiveness of magnesium sulfate for neuroprophylaxis and immediate intervention in hypertensive crises. Primary prevention has been strengthened by the categorical recommendation of low-dose Acetylsalicylic Acid (ASA) for high-risk pregnant women, initiated early. Therapeutic perspectives point toward direct modulation of the angiogenic axis. In conclusion, recent scientific advances have provided more effective diagnostic and preventive tools. However, the persistence of high maternal mortality rates, exacerbated by significant racial and socioeconomic disparities, indicates that the critical challenge lies in the universal and equitable implementation of these guidelines within the healthcare system. Overcoming inequities is essential to reducing maternal morbidity and mortality due to HDP.