Which medications are used in the treatment of severe hypertension during pregnancy?
Hypertensive disorders represent major causes of pregnancy-related maternal mortality worldwide. Similar to the non-pregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 6-8 % of pregnancies. A recent report highlighted …
How is mild to moderate hypertension (high blood pressure) managed during pregnancy?
Moderate quality of evidence was observed for direct comparison estimate between labetalol and hydralazine but was either low or very low for other comparisons. Conclusion: The present evidence suggests similar efficacy between nifedipine, hydralazine and labetalol in the treatment of severe hypertension in pregnancy.
When is no antihypertensive therapy indicated in pregnant women with chronic hypertension?
· Labetalol: a beta-blocker, which helps to slow your heart rate. Hydralazine: a vasodilator, which relaxes blood vessels to promote blood flow. Nifedipine: a calcium-channel blocker, which also eases the blood vessels to prevent the heart from needing to pump so hard 1.
When should I take my blood pressure medications during pregnancy?
The choice of anti-hypertensive medication in pregnancy has been limited to those that are considered relatively safe, have a long history of clinical use, and have side-effect profiles that physicians have found to be acceptable ( Table 2 ). The NHBPEP recommends α-methyldopa or hydralazine as initial pharmacologic agents.
What is the drug of choice for hypertension in pregnancy?
Methyldopa is a drug of first choice for control of mild to moderate hypertension in pregnancy and is the most widely prescribed antihypertensive for this indication in several countries, including the US and the UK.
Which drugs are best for treating severe hypertension in pregnancy?
Labetalol, nifedipine and hydralazine are the commonly used drugs for treating severe hypertension in pregnancy 8.
Why is labetalol used in pregnancy?
High blood pressure in pregnancy can cause complications for mother and baby. Labetalol is a blood pressure medication that is recommended for use in pregnancy as it has been shown to work well to lower blood pressure and it has a licence for use in pregnancy.
Can ACE inhibitors be used in pregnancy?
It is well accepted that angiotensin-converting enzyme (ACE) inhibitors are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage. First-trimester use, however, has not been linked to adverse fetal outcomes.
How is chronic hypertension treated in pregnancy?
For women with chronic hypertension who enter pregnancy not on antihypertensive treatment, ACOG recommends initiating antihypertensive treatment when blood pressures are consistently >160 mm Hg systolic and/or >105 mm Hg diastolic.
How is gestational hypertension treated?
Gestational Hypertension– High blood pressure that develops after week 20 in pregnancy and goes away after delivery....How is it treated?Rest, lying on your left side to take the weight of the baby off your major blood vessels.Increase prenatal checkups.Consume less salt.Drink 8 glasses of water a day.
What is severe hypertension in pregnancy?
Blood pressure criteria for hypertension in pregnancy are systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or both. Severe hypertension is defined as systolic blood pressure ≥160 mmHg, diastolic blood pressure ≥110 mmHg, or both [3].
Can you use medication to lower blood pressure during pregnancy?
Medications. Drug therapy is an effective, proven way to moderate blood pressure during pregnancy, though care must be used in selecting and administering drugs. Because drug therapy during pregnancy can carry risks for both the mother and the baby, it is usually reserved for use only in cases where the blood pressure is very high.
What to do if you have high blood pressure while pregnant?
If you have high-blood pressure during pregnancy, ACOG recommends regular prenatal check-ups for both you and your baby. Doctors are likely to perform the following tests to monitor your gestational hypertension:
Can pregnancy cause hypertension?
There are several strategies to treat hypertension that develops during pregnancy. These strategies are similar to those used to treat preeclampia, which is when a pregnant person has gestational hypertension as well as increased levels of protein in their urine. Up to half of people with gestational hypertension go on to develop preeclampsia or symptoms consistent with it. 1
Can gestational hypertension cause preeclampsia?
Up to half of people with gestational hypertension go on to develop preeclampsia or symptoms consistent with it. 1. In choosing a specific treatment plan, details such as blood pressure levels, how far along the pregnancy is, and how well the baby is doing will all be considered. It used to be common for doctors to prescribe bed rest ...
Why is it important to treat pregnancy?
The main goal of treatment is to prevent the development of more serious conditions. Pregnant parents can develop seizures or placental abruption, while their babies can be harmed by fetal growth restriction, pre-term delivery, or stillbirth. 1.
Can you take angiotensin II during pregnancy?
Since the teratogenic risk of ACE inhibitors is thought to be related to a direct pharmacological effect of the drugs on fetal physiology, angiotensin II receptor antagonists are also not recommended in pregnancy. [ 1, 2]
Does hydralazine help with hypertension?
In general, effective long term antihypertensive therapy with hydralazine (e.g. for chronic hypertension in pregnancy) often requires combination therapy (typically with a sympatholytic agent such as methyldopa or a ß-blocker) and such combinations also help attenuate reflex sympathetic activation associated with hydralazine.
Is hydralazine safe for pregnancy?
[ 1] . Hydralazine appears to be reasonably safe for the fetus although a few cases of fetal thrombo cytopenia have been reported. [ 1] .
Does methyldopa affect blood pressure?
During long term use in pregnancy, methyldopa does not alter maternal cardiac output or blood flow to the uterus or kidneys, [ 1, 2] and for all these reasons is generally considered the agent of choice for chronic blood pressure control in pregnancy. [ 1]
Is labetalol safe for pregnant women?
However, because the safety record of labetalol in pregnancy is not as well established as that of methyldopa, labetalol should probably be considered a second-line agent for pregnant women with chronic hypertension requiring long term drug therapy. [ 1]
What are the effects of ACE inhibitors?
Administration of ACE inhibitors during the second and third trimesters can result in a number of fetal adverse effects, including growth retardation, renal failure, persistent patent ductus arteriosus, respiratory distress syndrome, fetal hypotensive syndrome, and prepartum death. [ 12] . Although the magnitude of the risk is unknown, these agents ...
Is labetalol a vasodilator?
The combined and ß-adrenoceptor blocker labetalol is a peripheral vasodilator which has been shown to be effective in pre-eclamptic and non-proteinuric hypertension in pregnancy. [ 1] . Available data suggest that the antihypertensive effect is not associated with compromised renal or uterine blood flow. [ 1] .
What is gestational hypertension?
Gestational hypertension. Hypertension occurring in the second half of pregnancy in a previously normotensive woman, without significant proteinuria or other features of pre-eclampsia, is termed gestational or pregnancy induced hypertension. It complicates 6–7% of pregnancies7and resolves post partum.
Can antihypertensive drugs cross the placenta?
All antihypertensive drugs have either been shown, or are assumed, to cross the placenta and reach the fetal circulation . However, as previously stated, none of the antihypertensive agents in routine use have been documented to be teratogenic, although ACE inhibitors and ARBs are fetotoxic.
What is the most common medical problem during pregnancy?
Hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal, and fetal, morbidity and mortality. It complicates up to 15% of pregnancies and accounts for approximately a quarter of all antenatal admissions. The hypertensive disorders of pregnancy cover a spectrum of conditions, ...
When does blood pressure drop during pregnancy?
This reduction in blood pressure primarily affects the diastolic pressure and a drop of 10 mm Hg is usual by 13–20 weeks gestation.1Blood pressure continues to fall until 22–24 weeks when a nadir is reached. After this, there is a gradual increase in blood pressure until term when pre-pregnancy levels are attained.
When does pre-eclampsia occur?
Pre-eclampsia usually occurs after 20 weeks gestation and is a multi-system disorder. It was classically defined as a triad of hypertension, oedema, and proteinuria, but a more modern definition of pre-eclampsia concentrates on a gestational elevation of blood pressure together with > 0.3 g proteinuria per 24 hours.
What is the pathogenesis of pre-eclampsia?
The pathogenesis and manifestations of pre-eclampsia can be considered in a two stage model. The primary stage involves abnormal placentation. In the first trimester, in a healthy pregnancy, the trophoblast invades the uterine decidua and reaches the inner layer of the myometrium.
Is methyldopa safe for pregnancy?
Methyldopa is a centrally acting agent and remains the drug of first choice for treating hypertension in pregnancy. It has been the most frequently assessed antihypertensive in randomised trials and has the longest safety track record.
