Chronic Hypertension

Résumé fourni par la source

Hypertension is the commonest medical complication in pregnancy. Hypertensive disorders of pregnancy comprise chronic hypertension, gestational hypertension and pre-eclampsia. Chronic hypertension is defined as sustained hypertension above 140/90 mmHg at or before 20 weeks’ gestation, or persisting beyond 6 weeks postpartum, and is thought to affect 3% of the pregnant population. Women with chronic hypertension are at increased risk of pregnancy complications, including pre-eclampsia (26%), fetal growth restriction (20%), preterm birth (28%) and perinatal death. All women should be offered low-dose aspirin during pregnancy, and lifestyle modifications are advised to reduce risk of complications. Women should be investigated for secondary causes of hypertension and receive heightened antenatal surveillance, including regular ultrasound assessment of fetal growth. Anti-hypertensives, including labetalol, nifedipine or methyldopa, should be initiated if blood pressure is greater than 140/90, with target blood pressure >135/85 mmHg once treatment has commenced. Postnatally, women need close monitoring and methyldopa should be stopped (due to risk of postnatal depression) and medications switched to once-daily preparations, if possible. Risk factors for future cardiovascular disease should be assessed and optimised.

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