Hypertension in Pregnancy: Clinical Manifestations and Treatment
Almost 10% of pregnancies are complicated with hypertension. Chronic hypertension, gestational
hypertension, preeclampsia and preeclampsia superimposed on chronic hypertension is the most reliable classification in
obstetrical practice. Blood pressure higher than 140/90 mmHg before 20 weeks of gestation is defined as chronic
hypertension. Almost 25% of women with chronic hypertension will develop preeclampsia during pregnancy.
Pharmaceutical approach is unnecessary for mild hypertension, while α-methyldopa, labetalol and nifedipine are the most
common agents used for blood pressure more than 150/110mmHg. However, the above mentioned treatment does not
improve perinatal outcomes neither preclude progress of the disease in preeclampsia. Gestational hypertension (elevated
blood pressure after 20 weeks of gestation, without proteinuria) can be treated in the same manner. The former therapies
contribute significantly to prevention of maternal end-organs damage. Preeclampsia is characterized by the development
of hypertension and proteinuria after 20 weeks of gestation. It is a multiorgan disease in which the target organ is the
endothelium, the brain (eclampsia), the liver, the coagulation system (HELLP syndrome), or the kidney (glomerular
endotheliosis). Delivery still remains the only treatment in cases of severe preeclampsia and HELLP syndrome.
Intravenous use of hydralazine, labetalol or nifedipine is the treatment of choice for the control of blood pressure in
severe preeclampsia, while special care must be given to the use of anticonvulsive therapy for the prevention of seizures
and to the administration of corticosteroids for fetal lung maturity acceleration.
The management of hypertension in pregnancy must be individualized, while thorough counseling must be given to the
parents concerning maternal health and fetal safety.
Keywords: Hypertension, pregnancy, preeclampsia, HELLP syndrome, eclampsia, hypoplasia, gestational diabetes, chronic hypertension
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