Pharmacological Treatment of Hypertension in Pregnancy

Abstract

The hypertensive disorders of pregnancy complicate 5-10% of pregnancies. Of these disorders 70% are pregnancy related (preeclampsia-eclampsia and gestation hypertension) and 30 % are a pre-existing hypertensive condition (chronic hypertension). These disorders are associated with maternal and fetal complications and have a substantial economic impact. This review examined the pharmacological treatment of the hypertensive disorders of pregnancy. There is a general consensus that anti-hypertensive should be given with severe hypertension and this should be in the hospital. The value of antihypertensive drugs in pregnant women with mild hypertension continues to be an area of debate that the evidence is too scanty to securely evaluate the clinical benefits of treating mild hypertension during pregnancy. The choice of the antihypertensive agents depends on individual clinician preference, the specified maternal and foetal benefits and the reproductive complications (teratogenisity, fetotoxicity and neonatal toxicity) of each particular agent. There are unequivocal evidences that Magnesium sulphate is superior to other agents in reducing recurrent eclamptic seizures. There is a strong recent evidence recommended that magnesium sulphate should be considered for women with pre-eclampsia for whom there is concern about the risk of eclampsia.

Antihypertensive Medication Use During Pregnancy and the Risk of Cardiovascular Malformations

“…1-11 The ␤-blocker atenolol has been associated with intrauterine growth retardation. [1][2][3][4][5][6][12][13][14] One concern is that hypertension or iatrogenic hypotension might cause cardiovascular malformations (CVMs) by altering perfusion in the placenta and/or fetus. [15][16][17][18][19] In rats, abnormal cardiac development has resulted from exposures to calcium channel blockers, angiotensin II receptor blockers, and centrally acting antiadrenergic agents.…”

“…H ypertension occurs in 5% to 10% of pregnancies, [1][2][3][4][5][6] yet information on the safety of antihypertensive medication use during pregnancy is limited. For severe hypertension, antihypertensive medication is used to prevent serious maternal and fetal complications; however, there is no consensus on when to treat mild-to-moderate hypertension.…”

Perioperative considerations for neurosurgical procedures in the gravid patient: Continuing Professional Development

“…26 The role of triple-H therapy (hypervolemia, hypertension, and hemodilution) is not well established during pregnancy; moreover, this therapy can cause fluid overload, pulmonary edema, and myocardial ischemia.…”

“…26 Le rôle de la thérapie triple-H (hypervolémie, hypertension, et hémodilution) n'est pas clairement établi pendant la grossesse; de plus, ce traitement peut provoquer une surcharge liquidienne, un oedème pulmonaire et une ischémie myocardique. L'anesthésie régionale L'anesthésie régionale minimise indubitablement les complications liées aux voies aériennes associées à l'anesthésie générale, notamment l'échec de l'intubation trachéale et l'inhalation.…”

Estudo hemodinâmico materno fetal pré e pós tratamento de crise hipertensiva

“…Destas pacientes, 30% são hipertensas crônicas e o restante desenvolve pré-eclâmpsia/eclâmpsia e hipertensão gestacional (AFIFI, 2003).…”