pregnancy-induced hypertension; gestational hypertension (PIH)
Jump to navigation
Jump to search
Introduction
Hypertension without proteinuria diagnosed after 20 weeks of gestation, resolving within 12 weeks of delivery.[1]
Etiology
- hypertension due to pregnancy
Laboratory
- urine protein: proteinuria suggest pre-eclampsia
Complications
- pre-eclampsia/eclampsia
- development of chronic hypertension
Management
- if BP < 160/100, treatment is not indicated[2][4]
- treatment indicated for BP > 180/110
- alpha-methyldopa (Aldomet)
- labetolol[1][2] (first line)
- hydralazine#[3]
- nifedipine*
- diuretics are OK[2]
- ACE inhibitors are CONTRAINDICATED[2]
- atenolol is CONTRAINDICATED[2]
- vitamin C & vitamin E of no benefit in preventing complications[5]
- prophylaxis for pre-eclampsia & stroke in high-risk patients
* alternative agent
# adverse effects (headache, nausea, vomiting mimick worsening preeclampsia[3]; hydralazine associated with higher risk of adverse outcomes than nifedipine or labetolol[3]
Notes
- in general, pregnancy results in a lowering of blood pressure
More general terms
More specific terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Prescriber's Letter 8(9):53 2001
- ↑ 3.0 3.1 3.2 3.3 Journal Watch 23(24):192, 2003 Magee LA et al, BMJ 327:955, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14576246 <Internet> http://bmj.bmjjournals.com/cgi/content/full/327/7421/955
- ↑ 4.0 4.1 Prescriber's Letter 15(4): 2008 Treating High Blood Pressure in Pregnancy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240412&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 Roberts JM et al Vitamins C and E to Prevent Complications of Pregnancy- Associated Hypertension New Engl J Med 2010, 362:1282-1291 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20375405 <Internet> http://content.nejm.org/cgi/content/short/362/14/1282
- ↑ 6.0 6.1 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 125: Chronic hypertension in pregnancy. Obstet Gynecol. 2012 Feb;119(2 Pt 1):396-407. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22270315
- ↑ Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med. 2011 Aug 4;365(5):439-46. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21812673
- ↑ Yoder SR, Thornburg LL, Bisognano JD. Hypertension in pregnancy and women of childbearing age. Am J Med. 2009 Oct;122(10):890-5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19786154
- ↑ Lykke JA, Langhoff-Roos J, Sibai BM et al Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension. 2009 Jun;53(6):944-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19433776
- ↑ Noori M, Donald AE, Angelakopoulou A, Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation. 2010 Aug 3;122(5):478-87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20644016
- ↑ Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension. 2008 Apr;51(4):960-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18259046
- ↑ 12.0 12.1 Bushnell C et al Guidelines for the Pevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. Feb 6, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24503673 <Internet> http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48.full.pdf+html
- ↑ 13.0 13.1 Hofmeyr GJ et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014 Jun 24; 6:CD001059 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24960615
- ↑ 14.0 14.1 Tita AT et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022 Apr 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35363951 https://www.nejm.org/doi/10.1056/NEJMoa2201295