Elevated Blood Pressure and Stage 1 Hypertension in Pregnancy: A Review of the Literature

Abstract

Importance: Maternal and perinatal morbidity/mortality is significantly increased in pregnancies complicated by hypertension. The definition of hypertension has recently changed with the addition of 2 categories: elevated blood pressure (BP) and stage 1 hypertension. Should these categories be considered during pregnancy?Objective: The aim of this study was to analyze the impact of the new hypertensive categories of elevated BP and stage 1 hypertension on maternal/perinatal outcomes.Methods: Literature search of PubMed, Web of Science, and CINAHL search was undertaken. Citations were limited to the past 20 years.Results: Of the 333 articles identified, 26 articles were the basis of this review. In 2017, new guidelines on the diagnosis and management of hypertension were published. Prepregnancy hypertension was replaced by elevated BP (systolic BP 120-129 mm Hg and diastolic BP <80 mm Hg) and stage 1 hypertension (systolic BP 130-139 mm Hg and diastolic BP 80-89 mm Hg). The risk factors for elevated BP and stage 1 hypertension are similar to chronic hypertension (CHTN) risk factors, diagnosed by BP readings before pregnancy or before 20 weeks' gestation. Patients with elevated BP and stage 1 hypertension are at increased risk for hypertensive disorders of pregnancies compared with normal patients. Treatment strategies for elevated BP and stage 1 hypertension are uncertain. Before 2017, these patients would not have been considered hypertensive and no guidelines existed.Conclusions: Elevated BP and stage 1 hypertension increase the number of women labeled with hypertension in pregnancy. These women are at increased risk for adverse perinatal and maternal outcomes. There are currently no firm guidelines on management during pregnancy.Target Audience: Obstetricians and gynecologists, family medicine physicians Learning Objectives: After completion of this article, the reader should be better able to evaluate the published literature regarding elevated BP and stage 1 hypertension and associated outcomes; identify additional risks of pregnancy associated with these conditions; and analyze current recommendations regarding management during pregnancy.Chronic hypertension (CHTN), which complicates up to 1.5% of all pregnancies, has been steadily increasing since 1970 because of advancing maternal age and the growing obesity epidemic. 1 Traditionally, hypertension was diagnosed if the systolic blood pressure (SBP) was ≥140 mm Hg or the diastolic blood pressure (DBP) was ≥90 mm Hg. In pregnancy, the cutoffs for diagnosing both CHTN and gestational hypertension (GHTN) or preeclampsia were similar blood pressures (BPs) of ≥140 mm Hg SBP and/or ≥90 mm Hg DBP with the cutoff for the diagnosis of CHTN versus GHTN/ preeclampsia being 20 weeks of gestation. Chronic hypertension in pregnancy includes risks to both the fetus All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.

Quality and Content Concordance of International Clinical Guidelines on Hypertensive Disorders of Pregnancy Using the AGREE II Instrument: An Updated Systematic Review

“…HDPs have been classified into four categories: gestational hypertension, preeclampsia/eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia/eclampsia [4,5]. In 2017, elevated blood pressure and stage 1 hypertension were also suggested as hypertensive disorders during pregnancy, thus emphasizing the growing burden of these disorders [6], and the need for blood pressure monitoring. Risk factors for chronic hypertension (high blood pressure before pregnancy or before 20 weeks of pregnancy) can be modified by changes in diet, physical activity, tobacco, alcohol consumption and weight management.…”