The management of hypertension in women planning for pregnancy

Abstract

Introduction or backgroundPoorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension.Sources of dataPubMed.Areas of agreementMethyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant.Areas of controversyThere is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin.Growing pointsA less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders. Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy.Timely areas for developing researchLarge, worldwide, randomized trials should be conducted to see the outcomes for hypertensive women who take antioxidants/physical activity before pregnancy.

Untargeted analysis of first trimester serum to reveal biomarkers of pregnancy complications: a case–control discovery phase study

“…www.nature.com/scientificreports/ Exogenous metabolites Monohexyl phthalate was correlated with HDP and GH, and phthalate metabolites were weakly associated with decreased blood pressure in the second trimester in one previous study 27 . The correlation between salicylamide and PE may be due to the usage of aspirin-like medication (such as Labetalol, 2-hydroxy-5-[1-hydroxy-2-[(1-methyl-3-phenylpropyl)amino]ethyl]benzamide monohydrochloride), in hypertensive women 28 . (In our study, salicylamide levels were higher for the 5 women in the study, 4 cases and 1 control, who had chronic hypertension.)…”

A mushroom diet reduced the risk of pregnancy-induced hypertension and macrosomia: a randomized clinical trial

“…In response to the pathogenesis of hypertensive disorders such as preeclampsia in pregnancy, antioxidants such as vitamin C and E and resveratrol are provided as supplements to the diet. However, the results of clinical trials are not consistent or even on the contrary, mainly due to its poor membrane penetration (7,9). B vitamins, such as Vitamin B12, can reduce homocysteine in pregnant women, which is thought to be related to hypertension (7).…”

“…Conventional non-pharmacological treatments, such as exercise, weight loss and low-salt diets, are not recommended for pregnant women (8). For Methyldopa, although the data show that the offspring of mothers who had taken the drug have not had obvious symptoms of growth and development abnormalities; the safety concern remains for the wide usage in pregnant women (8,9).…”

Serum uric acid and risk of incident hypercholesterolaemia and hypertriglyceridaemia in middle-aged and older Chinese: a 4-year prospective cohort study

“…Moreover, another important factor may be the use of antihypertensive agents such as thiazide diuretics which are known to increase SUA levels [27]. In China, diuretics belong to the most frequently prescribed first-line therapy of hypertension [33]. China Hypertension Survey (2012-2015) reported that the prevalence of hypertension was 24.50% in men and 21.90% in women [34].…”