Hypertension in pregnancy

Czech version

Authors: Vysočanová M.; Floriánová A.; Špinar J.
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno
Published in: Kardiol Rev Int Med 2018, 20(4): 251-255

Overview

Hypertension complicates 5–10% of pregnancies and is responsible for substantial maternal/foetal and neonatal morbidity and mortality. Although not uniform, the preferred definition is based on absolute blood pressure (BP) values (systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg). Hypertension in pregnancy is divided into 4 categories: pre-existing hypertension, gestational hypertension, pre-existing hypertension with superimposed gestational hypertension with proteinuria and unclassifiable hypertension. Non-pharmacological treatment of hypertension should be considered in women with BP of 140–150/90–99 mmHg. Salt restriction or weight reduction is not recommended. Pharmacological treatment is recommended in all pregnant women with BP ≥ 150/95. Antihypertensive treatment should be considered at values ≥ 140/90 mmHg in women with gestational hypertension, pre-existing hypertension with superimposed gestational hypertension or hypertension with target organ damage. Methyldopa, calcium-channel blockers and beta-blockers are drugs of choice. ACE inhibitors and AT1 blockers, spironolactone and atenolol are contraindicated in pregnancy. Intravenous labetalol can be given for severe and complicated hypertension. Drugs of second choice in hypertensive emergencies are nitroprusside IV, or IV urapidil. All antihypertensive drugs taken by nursing mothers are excreted into breast milk, but most of them are present at very low concentrations. Hypertension in pregnancy is a marker for future cardiovascular and metabolic diseases.

Key words:

hypertension – pregnancy – gestational hypertension – pre-eclampsia

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