Health Questions and Answers

Question: Can anything be done to prevent complications in patients with chronic hypertension?

Answer:

There is no apparent benefit to treatment of mild chronic hypertension (systolic blood pressure 140-179 mmHg, diastolic blood pressure 90-109 mmHg) in pregnancy. Patients who are newly diagnosed with mild disease during pregnancy can be monitored off medication for signs of worsening hypertension or superimposed preeclampsia. Patients with chronic hypertension should ideally have their blood pressure under control when they conceive and should continue blood pressure medications when they are pregnant.
If your patient has more severe chronic hypertension, remember that angiotensin-converting enzyme (ACE) inhibitors are contraindicated in pregnancy. If a pregnant woman is taking an ACE inhibitor, her medical regimen should be changed prior to attempting conception or as soon as the pregnancy is diagnosed. There are a number of effective medications that appear safe in pregnancy. Alpha-methyldopa has been used safely for decades. Labetalol and calcium channel blockers also appear to be safe and effective. Beta blockers have been used, but there is a link between these drugs and small-for-gestational-age births.
Because of the risks associated with chronic hypertension, most clinicians follow pregnancies complicated by the disorder with serial ultrasounds for fetal growth and a schedule of fetal surveillance with nonstress tests or biophysical profiles. However, there are no data to support this approach. In general, these pregnancies are not allowed to continue past the due date and are induced at 40 weeks.

Reference: American College of Obstetricians and Gynecologists: Chronic Hypertension in Pregnancy. ACOG Practice Bulletin No. 29. Obstet Gynecol 98:177-185, 2001

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