HTN in pregnancy

HTN in pregnancy

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  HYPERTENSION DURING PREGNANCY Dr. SayeedurRahman Khan Rumi [email protected] MD Final Part Student NHFH&RI
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  Classification of Hypertension DuringPregnancy • Hypertension occurring during pregnancy falls into one of four major classifications: 1. Chronic hypertension 2. Gestational hypertension (also called transient hypertension) 3. Preeclampsia-eclampsia (also called pregnancy-induced hypertension) 4. Preeclampsia superimposed on underlying hypertension
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  Chronic hypertension • Thepresence of hypertension before the 20th week of gestation or • Persistent hypertension for longer than 12 weeks postpartum. • Causes: o Primary = “Essential Hypertension” o Secondary = Result of other medical condition (ie: renal disease)
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  Gestational hypertension • Alsocalled transient hypertension • Elevated blood pressure first detected after 20 weeks of gestation • Without proteinuria
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  Preeclampsia-eclampsia • Also calledpregnancy-induced hypertension • Defined by new onset of hypertension with a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg after the 20th week of gestation in a previously normotensive woman, • Which is accompanied by <300 mg proteinuria in 24 hours.
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  Preeclampsia-eclampsia (Cont’d) • Preeclampsiaoccurs in approximately 5% of pregnancies. • It is associated with significant maternal and fetal risk. • In preeclamptic hypertension, the reasonable goals for- systolic blood pressure is 140 to 155 mm Hg and diastolic is 90 to 105 mm Hg.
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  Chronic hypertension • Formanagement and counseling purposes, chronic hypertension in pregnancy is also categorized as either – low risk or – high risk • The patient is considered to be at low risk when she has mild essential hypertension without any organ involvement. • Women with low-risk chronic hypertension without superimposed preeclampsia usually have a pregnancy outcome similar to that in the general obstetric population.
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  Chronic hypertension (Cont’d) •Initiation of therapy is usually considered in women without end-organ damage if systolic blood pressure exceeds 160 mm Hg or diastolic pressure exceeds 110 mm Hg. • In women with end-organ damage, it is desirable to keep the blood pressure below 140/90 mm Hg.
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  Algorithm for themanagement of pregnant women with chronic hypertension.
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  Pharmacological therapy
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  • ACEIs andARBs are contraindicated and should be discontinued as soon as pregnancy is detected. • Women of child-bearing potential should be counseled about the teratogenic potential of these agents. • If drug therapy is necessary, methyldopa (250 mg twice daily orally; maximum dose, 4 g/d) has a long track record of safety and efficacy in pregnant patients and is often the initial drug of choice. • Hydralazine and β-blockers such as labetalol (100 mg twice daily orally; maximum dose, 800 mg every 8 hours) can also be used. • Atenolol, a β-blocker without α-blocking properties, is associated with lower placental and fetal weight at delivery when used early in pregnancy.
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  ESC guideline onCardiovascular Diseases during Pregnancy
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  Antihypertensive drugs inpregnancy & doses
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  Thank you