When hypertension is first identified during a womans pregnancy and she is at less than 20 weeks gestation blood pressure elevations usually represent chronic hypertension. The use of diuretic therapy during pregnancy remains controversial primarily due to theoretical concerns about reduced plasma volume.
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5High-risk co-morbidities for which treatment may be indicated.
How to treat chronic hypertension in pregnancy. To accomplish this goal it is important that women with chronic hypertension let their doctors know when they are planning a pregnancy so that they can receive pregnancy counseling and so that adjustments to antihypertensive medications can be made. 5 however many investigators support the concept that pregnancy hypertension may be termed chronic hypertension if it persists beyond 12 weeks after delivery. 1310 Consider labetalol to treat chronic hypertension in pregnant women.
The ESC suggests that gestational hypertension should resolve within 42 days postpartum which is the puerperal period and that preexisting hypertension persists beyond this period. Pregnancies complicated by chronic hypertension carry a heightened risk of superimposed preeclampsia which is associated with high rates of adverse maternal and perinatal outcomes. Medical treatment of chronic hypertension in pregnancy that is hypertension present before 20 weeks gestation is recommended at 160 mm.
High blood pressure which is present prior to pregnancy. Some women will later develop preeclampsia while others probably have high blood pressure chronic. Chronic hypertension is defined as blood pressure exceeding 14090 mm Hg before pregnancy or before 20 weeks gestation.
Consider nifedipine 3 for women in whom labetalol is not suitable or methyldopa if both labetalol and nifedipine 3 are not suitable. The combined α- and β-blocker labetalol is often recommended as an alternative first-line 1 30 or second-line agent 35 for the treatment of hypertension in pregnancy. In a randomized trial of women with chronic hypertension in pregnancy the use of diuretics reduced plasma volume but was not associated with adverse pregnancy outcomes.
Women on maintenance diuretic therapy prior to pregnancy can be continued. Management of chronic hypertension in pregnancy. Chronic hypertension with superimposed preeclampsia.
4 Sibai and colleagues 4 documented the rate of superimposed preeclampsia among 763 women with chronic hypertension who were followed prospectively at several medical centers in the United States. When managed appropriately most women with chronic hypertension can experience healthy pregnancies and give birth to healthy babies. Labetalol compared with α-methyldopa or no treatment was studied in a population of 300 women with chronic hypertension.
2Patients currently treated with 1 antihypertensive medication more likely to have severe chronic hypertension. 1718 ESC also includes a category antenatally unclassifiable hypertension. Up to 6 of pregnant women in the United States suffer from chronic hypertension but current guidelines from the American College of Obstetricians and Gynecologists ACOG recommend not giving anti-hypertensive medication to those with high.
Advise women who take angiotensin-converting enzyme ACE inhibitors or. High blood pressure is noted in the latter part of pregnancy but no other signs or symptoms of preeclampsia are present. 4Known secondary cause of chronic hypertension.
The evidence base for treatment of mild to moderate chronic hypertension in pregnancy resides in maternal benefit rather than clear evidence of an enhanced perinatal outcome for the baby. The most important thing to do is talk with your health care team about any blood pressure problems so you can get the right treatment and control your blood pressure before you get pregnant. 4 Some women with treated chronic hypertension are able to stop their medication in the first half of pregnancy because of the physiological fall in blood pressure during this period.
6 Thus some 15 years later we are still asking the question of whether to aggressively manage blood pressures in pregnant patients with mild chronic hypertension. In women with hypertensive disorders in pregnancy ABPM has modest prognostic value in predicting adverse outcomes but further research is necessary to define its role in clinical management of hypertensive disorders in pregnancy. Class C or higher diabetes mellitus.
However this is usually temporary and women are monitored and treatment. Developing hypertension later in pregnancy 33. 2010 amended 2019 132.
Preeclampsia which develops in someone who has chronic hypertension high blood pressure before pregnancy. The variable andor ambivalent outcomes of such studies have led the American College of Obstetricians and Gynecologists to consistently opine against starting or continuing antihypertensives for mild chronic hypertension in pregnancy. Offer women with chronic hypertension referral to a specialist in hypertensive disorders of pregnancy to discuss the risks and benefits of treatment.
Classification of hypertensive disorders in pregnancy This classification of the hypertensive disorders in pregnancy. Getting treatment for high blood pressure is important before during and after pregnancy.
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