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Feature Article

Management of chronic hypertension in pregnancy

Lawrence P McMahon

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An updated version is available in the linked supplement

Abstract

Chronic hypertension in pregnancy is not uncommon. The clinician needs to distinguish between new-onset and chronic hypertension and be aware of possible secondary causes, particularly chronic kidney disease.

Key Points

  • About 10 to 12% of pregnancies are complicated by hypertension; 20% of these are due to chronic hypertension.
  • Pre-eclampsia is the most likely event to complicate the pregnancy of a woman with chronic hypertension.
  • Tests are indicated in all women with known chronic hypertension to assess the severity of the hypertension and to investigate possible secondary causes.
  • Antihypertensive treatment is recommended when the systolic or diastolic blood pressure consistently reaches or exceeds 160 mmHg and 100 mmHg, respectively. Admission to hospital or an antenatal day-assessment unit may be required for pregnant women with such blood pressure levels.
  • The decision to treat intermediate blood pressures of 140 to160 mmHg (systolic) or 90 to 100 mmHg (diastolic) is based on clinical opinion. Admission to hospital or an antenatal day-assessment unit is recommended for pregnant women with these blood pressures if new-onset proteinuria develops.
  • Methyldopa and labetalol are currently the agents of choice in hypertensive pregnant women due to their efficacy and safety profile.

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