Q&A: Treatment Of Hypertension in Pregnancy

Hypertension, either chronic or pregnancy-related, is a common complication of pregnancy. When severe, it can lead to stroke and death, but prompt recognition and treatment can reduce the risk of these complications. When hypertension is diagnosed in a pregnant woman, the major issues are establishing a diagnosis, deciding the blood pressure at which treatment should be initiated and the target blood pressure, and avoiding drugs that may adversely affect the fetus.

This article is for Medical Students & Professionals

This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Hypertension article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Terminology of hypertension in pregnancy
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Terminology of hypertension in pregnancy

The major hypertensive disorders that occur in pregnant women are:

• Preeclampsia (which may have severe features) and eclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) may be a variant of preeclampsia with severe features and is associated with hypertension in most, but not all, cases.
• Gestational hypertension.
• Chronic hypertension.
• Chronic hypertension with superimposed preeclampsia (which may have severe features).

MCQ: clinical scenario

A young woman develops mild hypertension that first develops during pregnancy. Which of the treatment strategies below is the most preferred first-line therapy for her:

a) Labetolol
b) Diuretic
c) Methyldopa
d) Calcium antagonist
e) Angiotensin-converting enzyme (ACE) inhibitors
f) Angiotensin II receptor antagonist

MCQ: answer

The correct answer is C

MCQ: explanation

Methyldopa is preferred as first-line therapy by many clinicians when hypertension develops during pregnancy. If it is not well tolerated, alternatives are available. Use of a diuretic, a mainstay of hypertension management, is considered controversial in pregnant patients but the primary concern is theoretical. Diuretics can be used if warranted. Experience with calcium antagonists is limited. Calcium channel blockers have been widely used for tocolysis and acute blood pressure reduction in the second half of pregnancy, but minimal information is available on fetal effects in early pregnancy.

Reference(s)
1). UpToDate: Treatment of hypertension in pregnant and postpartum women. Available online: https://www.uptodate.com/contents/treatment-of-hypertension-in-pregnant-and-postpartum-women