February 2006 · Vol. 18, No. 2Controlling chronic hypertension in pregnancy
How to identify women at highest risk, and select treatment during pregnancy and after delivery
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Fast Track
Use blood pressure at the initial visit to classify risk as low or high
We discontinue antihypertensive drugs in women at low risk, because outcomes are good without therapy
We hospitalize women with high-risk hypertension at the first visit, to evaluate cardiovascular and renal status and regulate medications
Methyldopa is a reasonable first-line oral antihypertensive for breastfeeding women
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Baha
M.
Sibai,
MDProfessor, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine,
Cincinnati, Ohio Labib
M.
Ghulmiyyah,
MDFellow, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine,
Cincinnati, Ohio
One unhappy effect of the obesity epidemic and the increasing age of women at childbirth is the rising prevalence of chronic hypertension, which climbed from 4.6% to 22.3% in women aged 30 to 39 years, and from 0.6% to 2.0% in women aged 18 to 29 years, according to the National Health and Nutrition Examination Survey for 1988–1991. These trends are expected to continue, and so are the rates of chronic hypertension in pregnancy, with its increased possibility of super-imposed preeclampsia.
This article outlines diagnosis and management, including:
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