Women HEalth and PREgnancy Complications (HER): a physician-based Survey on Hypertensive Disorders in Pregnancy of the Italian Society of Hypertension (SIIA)

Introduction: Management of hypertensive disorders in pregnancy (HDP) remains challenging, with various healthcare providers involved and no uniform approach with variability in medications, monitoring, and intervention timing reflecting gaps in research. Aim: To investigate Italian physicians' knowledge on the topic and examine their clinical practices. Methods: We collected multi-regional data from Italian experts on Hypertension and Gynecologists. The survey consisted of 18 multiple choice questions. Questions involved patient access pathways for suspected HDP, diagnostic assessments, first- and second-line therapies, follow-up visits modalities, and postpartum recommendations. Results: One-hundred and ten experts on hypertension and 31 gynecologists from third-referral centers of 16 over 20 Italian Regions participated in the survey. Only 27.7% of participants were aware of the actual risk of developing preeclampsia in women with chronic hypertension, and only one over two was aware of all long-term risks of cardiovascular disease. Hypertension specialists were in charge of the first antihypertensive prescription in less than 10% of HDP cases. Most common first-line agent was nifedipine and second-line agent nifedipine or methyldopa. Adding a second agent was slightly preferred over the use of maximum dosage of the first agent; 72.6% declared choosing the medication based on maternal hemodynamic profile. Consistent involvement of Hypertension Centers during both pregnancy and postpartum was reported only by 56.7% of physicians. Conclusions: The survey revealed significant gaps in awareness and management practices for women with HDP.