Peer Reviewed
Feature Article Cardiovascular medicine

Management of chronic hypertension in pregnancy

Lawrence P. McMahon
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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