What is the goal of hypertensive treatment in pregnant women?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

In patients who are pregnant, the goal of antihypertensive treatment is to minimize the risk of maternal cardiovascular or cerebrovascular events. Hypertensive disorders—categorized as chronic hypertension, preeclampsia, chronic hypertension with superimposed preeclampsia, gestational hypertension, and transient hypertension (see Table 3, below)— may contribute to maternal, fetal, or neonatal morbidity and mortality, particularly in the first trimester. [5]

Table 3. Hypertensive Disorders in Pregnancy (Open Table in a new window)

Classification

Characteristics

Chronic hypertension

Prepregnancy or before 20 weeks’ gestation; SBP =140 mm Hg or DBP 90 mm Hg that persists >12 weeks postpartum

Preeclampsia

After 20 weeks’ gestation; SBP =140 mm Hg or DBP 90 mm Hg with proteinuria (>300 mg/24 h)

Can progress to eclampsia

More common in nulliparous women, multiple gestation, women with hypertension =4 years, family history of preeclampsia, previous hypertension in pregnancy, and renal disease

Chronic hypertension with superimposed preeclampsia

New-onset proteinuria after 20 weeks in hypertensive woman

In a woman with hypertension and proteinuria before 20 weeks’ gestation

Sudden 2- to 3-fold increase in proteinuria

Sudden increase in BP

Thrombocytopenia

Elevated AST or ALT levels

Gestational hypertension

Temporary diagnosis

Hypertension without proteinuria after 20 weeks’ gestation

May be a preproteinuric phase of preeclampsia or a recurrence of chronic hypertension that abated in mid-pregnancy

May lead to preeclampsia

Severe cases may cause higher rates of premature delivery and growth retardation relative to mild preeclampsia

Transient hypertension

Diagnosis made retrospectively

BP returns to normal by 12 weeks’ postpartum

May recur in subsequent pregnancies

Predictive of future primary hypertension

ALT = alanine aminotransferase; AST = aspartate aminotransferase; BP = blood pressure; DBP = diastolic BP; SBP = systolic BP.

Adapted from:  Chobanian AV, Bakris GL, Black HR, et al, and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. Dec 2003;42(6):1206-52. [5]


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