Hypertension in pregnancy
Authors:
R. Cífková
Authors‘ workplace:
IKEM Praha, Pracoviště preventivní kardiologie
Published in:
Čas. Lék. čes. 2009; 148: 65-71
Category:
Review Article
Overview
The most important task of classification of hypertension in pregnancy is to establish whether hypertension predates pregnancy (so-called pre-existing hypertension) or whether this is pregnancy-induced hypertension (so-called gestational hypertension). Pre-existing hypertension is diagnosed either before pregnancy or within 20 weeks of gestation. Gestational hypertension is characterized by poor perfusion of several organs, and the elevated blood pressure (BP) represents usually only one of the characteristic features. Non--pharmacological treatment of hypertension should be considered in pregnant females with systolic BP 140–150 mm Hg or diastolic BP 90–99 mm Hg. Salt restriction or weight reduction is not recommended. Systolic BP ≥ 170 or diastolic BP ≥ 110 mm Hg in a pregnant woman should be regarded as an emergency requiring hospitalization. Drug treatment with intravenous labetalol, or oral methyldopa or nifedipine should be considered. The thresholds at which to initiate antihypertensive therapy is systolic BP of 140 mm Hg or diastolic BP of 90 mm Hg in women with gestational hypertension without proteinuria or in those with pre-existing hypertension before 28 weeks’ gestation. Drug treatment is to be initiated at the same threshold levels in females with gestational hypertension and proteinuria or those presenting with symptoms at any time during the pregnancy, those with pre-existing hypertension in the presence of associated conditions or organ damage and, also, those with pre-existing hypertension and superimposed gestational hypertension. In other cases, it is recommended to institute antihypertensive medication at systolic BP of 150 mm Hg or diastolic BP of 95 mm Hg. For non-severe hypertension, methyldopa, labetalol, calcium-channel blockers should be considered the drugs of choice. ACE inhibitors and angiotensin II antagonists (AT1-blockers) are contraindicated in pregnancy.
Key words:
pre-existing hypertension, gestational hypertension, non-pharmacological treatment of hypertension, methyldopa, labetalol, calcium-channel blockers, magnesium sulphate.
Sources
1. Garovic VD. Hypertension in pregnancy: Diagnosis and treatment. Mayo Clin Proceedings 2001; 75: 1071–1076.
2. National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy: Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; 183(Suppl): S1–S22.
3. Paller MS. Hypertension in pregnancy. J Am Soc Nephrol 1998; 9: 314–320.
4. Guidelines Committee. 2003 European Society of Hypertension – European Society of Cardiology guidelines for management of arterial hypertension: J Hypertens 2003; 21: 1011–1053.
5. Helewa ME, Burrows RF, Smith J, et al. Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy. Can Med Assoc J 1997; 157: 715–725.
6. Levine RJ, Ewell MG, Hauth JC, et al. Should the definition of preeclampsia include a rise in diastolic blood pressure of ≥ 15 mm Hg to a level < 90 mm Hg in association with proteinuria? Am J Obstet Gynecol 2000; 183: 787–792.
7. Mancia G, De Backer G, Dominiczak A, et al. Guidelines for the management of arterial hypertension. J Hypertens 2007; 25: 1105–1187.
8. Higgins JR, de Swiet M. Blood pressure measurement and classification in pregnancy. Lancet 2001; 357: 131–135.
9. Perry IJ, Stewart BA, Brockwell J, et al. Recording diastolic blood pressure in pregnancy. BMJ 1990; 301: 1198.
10. Shennan A, Gupta M, Halligan A, Taylor DJ, de Swiet M. Lack of reproducibility in pregnancy of Korotkoff phase IV as measured by mercury sphygmomanometry. Lancet 1996; 347: 139–142.
11. Task Force Members, Oakley C, Child A, et al. Expert consensus document on management of cardiovascular diseases during pregnancy. Eur. Heart J 2003; 24: 761–781.
12. Staessen JA, Asmar R, De Buyzere M, et al. Participants of the 2001 Consensus Conference on Ambulatory Blood Pressure Monitoring. Task Force II: blood pressure measurement and cardiovascular outcome. Blood Press Monit 2001; 6: 355–370.
13. Churchill D, Perry IJ, Beevers DG. Ambulatory blood pressure in pregnancy and fetal growth. Lancet 1997; 349: 7–10.
14. Penny JA, Halligan AW, Shennan AH, et al. Automated, ambulatory, or conventional blood pressure measurement in pregnancy: which is the better predictor of severe hypertension? Am J Obstet Gynecol 1998; 178: 521–526.
15. López-Jaramillo P, García RG, López, M. Preventing pregnancy–induced hypertension: are there regional differences for this global problem? J Hypertens 2005; 23: 1121–1129.
16. Kaplan NM. Kaplan’s clinical hypertension. Ninth Edition. Philadelphia: Lippincott Williams and Wilkins 2006; 518.
17. Rossi GP, Seccia TM, Pessina AC. Clinical use of laboratory tests for the identification of secondary forms of arterial hypertension. Crit Rev Clin Lab Sci 2007; 44: 1–85.
18. Grodski S, Jung C, Kertes P, et al. Phaeochromocytoma in pregnancy. Intern Med J 2006; 36: 604–606.
19. Moutquin JM, Garner PR, Burrows RF, et al. Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. Can Med Assoc J 1997; 157: 907–919.
20. Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996; 335: 257–265.
21. Magee LA, Ornstein P, von Dadelszen P. Fortnightly review. Management of hypertension in pregnancy. BMJ 1999; 318: 1322–1326.
22. Olsen SF, Secher NJ, Tabor A, et al. Randomised clinical trials of fish oil supplementation in high risk pregnancies. Br J Obstet Gynaecol 2000; 107: 382–395.
23. Olsen SF, Osterdal ML, Salvig JD, et al. Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil. Eur J Clin Nutr 2007; 61: 976–985.
24. Hofmeyr GJ, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2006; Issue 3, CD001059.
25. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. CLASP: a randomized trial of low dose aspirin for the prevention and treatment of preeclampsia among 9364 pregnant women. Lancet 1994; 343: 619–629.
26. Khedun SM, Moodley J, Naicker T, Maharaj B. Drug management of hypertensive disorders of pregnancy. Pharmacol Ther 1997; 74: 221–258.
27. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension 2008; 51: 960–969.
28. Dekker G, Sibai BM. Primary, secondary, and tertiary prevention of preeclampsia. Lancet 2001, 357: 209–215.
29. Magee LA, Cham C, Waterman EJ, Ohlsson A, et al. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 2003; 327: 955–960.
30. Lydakis C, Lip GYH, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12: 541–547.
31. Jonsdottir LS, Arngrimsson R, Geirsson RT, et al. Death rates from ischemic heart disease in women with a history of hypertension in pregnancy. Acta Obstet Gynecol Scand 1995; 74: 772–776.
32. Paradisi G, Biaggi A, Savone R, et al. Cardiovascular risk factors in healthy women with previous gestational hypertension. J Clin Endocrinol Metab 2006, 91: 1233–1238.
33. Seely EW. Hypertension in pregnancy: a potential window into long-term cardiovascular risk of women. Clin Endo Metab 1999; 84: 1858–1861.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- Hypertension in pregnancy
- Abdominal obesity
- Conservative treatment of diabetic microangiopathy and macroangiopathy
- Double-balloon enteroscopy