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pregnancy-induced hypertension; gestational hypertension (PIH)

Hypertension without proteinuria diagnosed after 20 weeks of gestation, resolving within 12 weeks of delivery. [1] Etiology: - hypertension due to pregnancy Laboratory: - urine protein: proteinuria suggest pre-eclampsia Complications: - pre-eclampsia/eclampsia - development of chronic hypertension Management: 1) if BP < 160/100, treatment is not indicated [2,4] a) goal is BP < 150/100 [1] b) use lower threshold if chronic renal failure [1] c) outcomes better with treatment to target of < 140/90 mm Hg [14] 2) treatment indicated for BP > 180/110 a) alpha-methyldopa (Aldomet) b) labetolol [1,2] (first line) c) hydralazine# [3] d) nifedipine* e) diuretics are OK [2] f) ACE inhibitors are CONTRAINDICATED [2] g) atenolol is CONTRAINDICATED [2] 3) vitamin C & vitamin E of no benefit in preventing complications [5] 4) prophylaxis for pre-eclampsia & stroke in high-risk patients - low dose aspirin 75-150 mg/day to inhibit formation of TxA2 [1,6,12] - calcium supplements may be of benefit [13] * alternative agent # adverse effects (headache, nausea, vomiting mimick worsening preeclampsia [3]; hydralazine associated with higher risk of adverse outcomes than nifedipine or labetolol [3] Notes: - in general, pregnancy results in a lowering of blood pressure

Specific

HELLP syndrome pre-eclampsia/eclampsia

General

hypertension during pregnancy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Prescriber's Letter 8(9):53 2001
  3. Journal Watch 23(24):192, 2003 Magee LA et al, BMJ 327:955, 2003 PMID: 14576246 http://bmj.bmjjournals.com/cgi/content/full/327/7421/955
  4. Prescriber's Letter 15(4): 2008 Treating High Blood Pressure in Pregnancy Detail-Document#: 240412 (subscription needed) http://www.prescribersletter.com
  5. Roberts JM et al Vitamins C and E to Prevent Complications of Pregnancy- Associated Hypertension New Engl J Med 2010, 362:1282-1291 PMID: 20375405 http://content.nejm.org/cgi/content/short/362/14/1282
  6. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 125: Chronic hypertension in pregnancy. Obstet Gynecol. 2012 Feb;119(2 Pt 1):396-407. PMID: 22270315
  7. Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med. 2011 Aug 4;365(5):439-46. PMID: 21812673
  8. Yoder SR, Thornburg LL, Bisognano JD. Hypertension in pregnancy and women of childbearing age. Am J Med. 2009 Oct;122(10):890-5 PMID: 19786154
  9. Lykke JA, Langhoff-Roos J, Sibai BM et al Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension. 2009 Jun;53(6):944-51 PMID: 19433776
  10. Noori M, Donald AE, Angelakopoulou A, Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation. 2010 Aug 3;122(5):478-87. PMID: 20644016
  11. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension. 2008 Apr;51(4):960-9 PMID: 18259046
  12. Bushnell C et al Guidelines for the Pevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. Feb 6, 2015 PMID: 24503673 http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48.full.pdf+html
  13. Hofmeyr GJ et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014 Jun 24; 6:CD001059 PMID: 24960615
  14. Tita AT et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022 Apr 2 PMID: 35363951 https://www.nejm.org/doi/10.1056/NEJMoa2201295