Hypertension in Pregnancy
While hypertension itself presents concerns during pregnancy, adverse effects from progression to pre-eclampsia/eclampsia along with HELLP syndrome present the primary concern - Richard Luger MD
image by: Pan African Conference on Hypertensive Disorders in Pregnancy
Hypertension in Pregnancy
HTN is the most common medical disorder during pregnancy, with a prevalence of 5-10% of all pregnancies worldwide. HTN and antihypertensive drugs have adverse effects on both the mother and the foetus. Management of HTN during pregnancy needs expertise in the field of high-risk pregnancy and cardiovascular diseases, which is why a combined team of obstetricians and cardiologists is an important prerequisite...
The nomenclature of the different forms of HDP depends on the timing of the first diagnosis of HTN and the persistence of high BP after delivery.
The following forms are described in the recent European guidelines:
- Pre-existing hypertension
Management of hypertension in pregnancy
Labetalol: 100 mg twice a day – 400 mg three times a day.
ACOG Guidance: Emergency Treatment for Severe Hypertension in Pregnancy
First Line Therapy: Nifedipine Hydralazine Labetalol
Drug Treatment of Hypertension in Pregnancy
In current practice, antihypertensive medications other than methyldopa and hydralazine are being used more often in pregnancy... Labetalol a non-selective β-blocking agent with vascular α-1-receptor blocking capabilities is widely used in pregnancy.
Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period
Intravenous (IV) labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although, relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the evidence available suggests that oral nifedipine also may be considered as a first-line therapy.
High blood pressure treatment in pregnancy is safe, prevents maternal heart risks
The latest American Heart Association statistics indicate hypertension during pregnancy, defined as a systolic pressure (the top number in a blood pressure reading) of 140 mm Hg or higher, is the second leading cause of maternal death worldwide.
Hypertension - Antenatal, Intrapartum and Postpartum
This guideline describes evidence-based care for women with hypertension and pre-eclampsia in pregnancy.
Hypertension in pregnancy: diagnosis and management
When using medicines to treat hypertension in pregnancy, aim for a target blood pressure of 135/85 mmHg. Consider labetalol to treat chronic hypertension in pregnant women. Consider nifedipine for women in whom labetalol is not suitable, or methyldopa if both labetalol and nifedipine. are not suitable
Hypertension in pregnancy: Pathophysiology and treatment
Intravenous hydralazine, immediate release nifedipine, and intravenous labetalol remain the drugs of choice for severe hypertension. Oral extended release nifedipine, oral labetalol, and methyldopa are the generally accepted first-line agents for non-severe hypertension. Beta-blockers and diuretics are acceptable, while RAAS inhibitors remain contraindicated.
Hypertensive Emergencies in Pregnancy
The 4 main categories of hypertensive disorders in pregnancy are chronic hypertension, gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia.
Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial
All oral antihypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs—methyldopa, nifedipine, and labetalol—are viable initial options for treating severe hypertension in low-resource settings.
Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review
The oral antihypertensive agent for which there is the most evidence for treatment of severe hypertension in pregnancy/postpartum is nifedipine (10 mg). Labetalol (100 mg) and methyldopa (250 mg) are reasonable second-line options based on far more limited data.
Oral Nifedipine versus Intravenus Labetalol
Nifedipine is more effective in severe pregnancy induced hypertension to achieve the target blood pressure as compared to labetalol. It is more suitable in our setup as it is economical and easy to administer.
Severe hypertension in pregnancy
Severe hypertension in pregnancy is defined as a sustained systolic blood pressure of 160 mmHg or over or diastolic blood pressure of 110 mmHg or over and should be assessed in hospital. Severe hypertension before 20 weeks’ gestation is rare and usually due to chronic hypertension; assessment for target organ damage and exclusion of secondary hypertension are warranted. The most common cause of severe hypertension in pregnancy is pre-eclampsia, which presents after 20 weeks’ gestation.
Hypertension in Pregnancy
Hypertension (HTN) is the most commonly encountered disorder during pregnancy. High blood pressure has a negative impact on the mother and the foetus, which is why early diagnosis and proper control are mandatory to avoid complications. There are many forms of HTN disorder during pregnancy. The threshold for initiation of antihypertensive medications differs for gestational and chronic HTN during pregnancy, being lower in gestational HTN. Pre-eclampsia/eclampsia syndrome is a severe form of gestational HTN, which is only curable by delivery of the foetus. Management of HTN during pregnancy is challenging and it requires collaboration between obstetricians and cardiologists.
Development of hypertension during pregnancy is associated with high maternal and fetal morbidity and mortality. In the US, hypertension during pregnancy results in maternal mortality rates of 2-7% each year.
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Last Updated : Friday, August 12, 2022