Hypertension Management In Pregnancy

Aug 31, 2023

What Is High Blood Pressure?

The cardiovascular system comprises the heart and arteries that conduct blood throughout the body. The normal blood pressure of an individual should be 120/80mmhg. However, in some cases, like in pregnancy, there is always a risk of increased pressure faced by the walls of arteries that result in hypertension.

Systolic pressure: When the heart pumps forcefully in a contraction to push the blood through the body, it is called systolic pressure. The average value is 120 mmHg.

Diastolic pressure: There is a state of relaxation between the heart contractions. In this phase, the heart relaxes and fills in the blood inside, called diastolic pressure. The average value is 80 mmHg.

Here is a chart representing high blood pressure categories:

Effects Of High Blood Pressure In Pregnancy

1. Preeclampsia: It's a condition where high blood pressure results in affecting organs like kidneys and liver. The severe symptoms of preeclampsia cause the loss of protein in the urine, throbbing headaches, blurry vision, difficulty breathing, swelling, and edema in the abdomen. It happens usually in the last trimester after the 20th week.

2. Eclampsia: It is a life-threatening condition where the blood pressure has reached peaks, resulting in seizures and coma.

3. Gestational hypertension: usually develops after the 20th week of pregnancy with no visible symptoms like proteinuria or organ damage. However, it might lead to preeclampsia.

4. Chronic hypertension: might begin in the early weeks of pregnancy or later trimesters. There isn't any specific reason for chronic hypertension.

5. HELLP syndrome: It is risky but rarely happens due to preeclampsia and eclampsia. In HELLP syndrome, there is damage to the liver and blood cells. HELLP stands for (H) Hemolysis, (EL) Elevated liver enzymes and (LP) Lower platelet count.

Treatment Of High Blood Pressure in Pregnancy

High blood pressure in pregnancy is usually managed by low doses of aspirin. However, severe hypertension is managed and controlled by various drugs. However, the safest options are:

●Methyldopa

●Labetalol

●Nifedipine

●Hydralazine

●Thiazide diuretics

The unsafe or contraindicated drugs in pregnancy are:

●Angiotensin receptor blockers

●Renin-inhibitors

●ACE inhibitors

These drugs cross the placental barrier and reach the circulatory system, causing poor fetus health.

Management Of High Blood Pressure in Pregnancy

●Throughout the pregnancy, weekly or monthly prenatal checkups are vital.

●Monitoring blood pressure regularly using accurate digital sphygmomanmeters. You can get it from Checkme.

●Adherence to hypertensive medicines.

●Eat a well-balanced diet and do sufficient hydration.

●Avoid stress or other strenuous activities.

●Reduce weight.

●Avoid smoking and alcohol.

●Avoid a diet rich in oil and salt or preservatives.

Risk factors/Causes For Hypertension/Preeclampsia

●Obesity

●Age above 40 years

●History of blood pressure in the family

●Higher blood pressure before conception and pregnancy

●Multiple pregnancies

●Kidney disease before pregnancy.

●History of diabetes, lupus, and blood diseases in the family.

●Pregnancy via invitro fertilization, egg donation, or ovulation induction.

References:

1.Duley, L., Meher, S., & Jones, L. (2013). Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database of Systematic Reviews.

2.Defining and Treating High Blood Pressure During Pregnancy. (2019, February 27). Healthline.

3.Medline Plus. (2019). High Blood Pressure in Pregnancy. Medlineplus.gov; National Library of Medicine.

4.Mayo Clinic. (2018). High blood pressure and pregnancy: Know the facts. Mayo Clinic.

5.Lindheimer, M. D., Taler, S. J., & Cunningham, F. G. (2010). Hypertension in pregnancy. Journal of the American society of Hypertension, 4(2), 68-78.

6.Magee, L. A., Ornstein, M. P., & Von Dadelszen, P. (1999). Management of hypertension in pregnancy. Bmj, 318(7194), 1332-1336.

WRITTEN BY Checkme

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