July 2003 · Vol. 15, No. 7Hypertension in pregnancy:
Tailoring treatment to risk
Not all hypertensive gravidas should receive drug therapy. In fact, antihypertensive medications should be halted in some patients. Here, 2 experts present a comprehensive plan for high- and low-risk women.
BAHA
M.
SIBAI,
MDMARK
CHAMES,
MDDr. Sibai is professor and chairman, and Dr. Chames is a fellow in maternal-fetal medicine, department of obstetrics and gynecology, University of Cincinnati,
Cincinnati, Ohio.
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KEY POINTS
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The treatment goal is to reduce blood pressure to a safe level to prevent maternal cerebral complications.This goal must be weighed against the risks of fetal exposure to antihypertensive drugs and the effects on uteroplacental blood flow.
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Gravidas with uncomplicated mild hypertension are at low risk; however, those with severe hypertension or associated complicating factors are at high risk of complications and adverse outcomes.
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Antihypertensive medications should not be used routinely in low-risk patients.
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Women with high-risk chronic hypertension are at risk for postpartum complications such as pulmonary edema, hypertensive encephalopathy, and renal failure.
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The decision to use antihypertensive drug therapy in pregnant women is a tricky one—especially considering the ever-evolving nature of treatment. For instance, we now know that in some hypertensive gravidas, medical interventions may actually be deleterious.
With the aging of the obstetric population in the United States, hypertension in pregnancy—which currently affects 7% of gestations—will remain a major issue in preconception and prenatal care. Its reported risks, which include stroke, pulmonary edema, and death, underscore the importance of careful management (TABLE 1).
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