Htn in pregnancy

1. HYPERTENSION DURING
PREGNANCY
Dr. Sayeedur Rahman Khan Rumi
Dr.rumibd@gmail.com
MD Final Part Student
NHFH&RI

2. Classification of Hypertension
During Pregnancy
• 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

3. Chronic hypertension
• The presence 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)

4. Gestational hypertension
• Also called transient hypertension
• Elevated blood pressure first detected
after 20 weeks of gestation
• Without proteinuria

5. Preeclampsia-eclampsia
• Also called pregnancy-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.

6. Preeclampsia-eclampsia (Cont’d)
• Preeclampsia occurs 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.

7. Chronic hypertension
• For management 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.

8. 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.

9. Algorithm for the management of pregnant women
with chronic hypertension.

10. Pharmacological
therapy

11. • ACEIs and ARBs 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.

12. ESC guideline on Cardiovascular Diseases during
Pregnancy

13. Antihypertensive drugs in pregnancy & doses

14. Thank you