Chronic Hypertension in Pregnancy

Abstract

Hypertensive syndromes in pregnancy, such as hemorrhagic and infectious conditions, are largely responsible for most maternal deaths in the world. It is estimated that chronic hypertension (CH) in pregnancy complicates about 6–8% of pregnancies, which can be aggravated when overlapping preeclampsia (PE) in 13–40% of cases. Differentiated prenatal care is a big step toward achieving efficient preventive and therapeutic aspects. Special attention should be paid to weight gain, uterine height, edema, and correct BP measurement, since such measures may lead to suspicion of complications in this group of patients. Hypertensive patients should have their routine of individualized consultations.The best available evidence supports two effective interventions to reduce the risks of developing PE, acetylsalicylic acid (ASA) in doses from 100 to 150 mg/day and calcium (Ca) supplementation above 1000 mg /day. The mode of delivery must follow obstetric principles. There are no reasons for systematic indication for cesarean section in patients with CH without complications. The use of magnesium sulfate should not be considered a limiting element for investment in the vaginal route.The choice of antihypertensive drugs should be based on clinical experience and availability of the drug. The most used alternatives are methyldopa, nifedipine, and labetalol. A stricter policy on blood pressure control reduces maternal risks related to hypertensive emergencies.Finally, all patients with CH should receive guidance on family planning. Long-term contraceptive methods should be encouraged in this group of at-risk patients, such as copper intrauterine devices (IUDs). We emphasize the recommendation by WHO of the possible insertion of this device at the time of delivery or in the first 48 h while still in the maternity ward.KeywordsHypertensionPreeclampsiaAntihypertensive agentsPrenatal care