Control of hypertension in pregnancy.

Control of Hypertension in Pregnancy

Approximately 5-10 % of pregnant women get hypertension during their pregnancy, and some questions arise about the benefit of lowering BP and what is the optimal BP target.

Hypertension in pregnancy has one of three categories:

Chronic or pe-existing hypertension: which is present in the first 20 weeks of gestation.
Gestational: after 20 weeks of gestation.
Pre-eclampsia: serious condition in third trimester.

The hypertensive pregnant lady has risk of maternal and fetal mortality and morbidity.

Classification:

Mild-moderate hypertension (140-159/90-109 mm Hg).

Severe hypertension (systolic > 160 , and /or diastolic BP >110 mm Hg).

CHIPS Trial (Control of Hypertension in Pregnancy Study)

This study compared :

“less tight” (target diastolic Blood pressure dBP=100 mm Hg) versus “Tight” control (target dBP=85 mm Hg),

The conclusion was the association between severe hypertension and serious maternal complications was seen only in the less tight control group and the opposite was seen in pregnant with mild-moderate hypertension. This trial showed that the less tight control is more affective on serious perinatal and maternal complications.

Treatment of Acute hypertension in pregnancy: The first line options is oral immediate release Nifedipine, or labetalol tab 200 mg repeated after 30 min till IV access is available then IV labetalol and hydralazine starte.

Treatment for chronic hypertension:

The first line of oral Labetalol 200 mg orally.

Methyldopa slow onset of action and associated with fatigue.

Other Beta Blocker (Metoprolol and nadolol).

Nifedipine (long acting) is also a reasonable medication.

The second lines are:

Clonidine – hydralazine – thiazide diuretic.

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