Health Questions and Answers

Question: What is the role of antihypertensives in preeclampsia?

Answer:

Mild elevations in blood pressure usually are not treated with antihypertensives. With more marked elevations (diastolic > 110 mmHg or a mean arterial pressure > 125 mmHg), medications with rapid onset, such as hydralazine and labetalol, are used intravenously. Generally such management is undertaken while also proceeding with delivery, due to the severity of the disease.
Diuretics are generally not used as a first-line treatment because preeclampsia is characterized by vasoconstriction and intravascular depletion, which are worsened by diuretics. As for other antihypertensive agents, work has shown that treatment of patients with mild-to-moderate hypertension (i.e., 90-110 mmHg diastolic pressure) does not decrease perinatal morbidity or mortality. Therefore, antihypertensive therapy is not usually used. Severe hypertension (> 110 mmHg diastolic pressure) is associated with severe preeclampsia. More than likely, delivery needs to be undertaken in this circumstance, and rapid-acting antihypertensive agents (i.e., intravenous hydralazine or labetalol) are used to control severe hypertension during labor.
In a patient with known chronic hypertension whose elevated blood pressure is believed to be due to underlying disease rather than preeclampsia, an increase in antihypertensive therapy may be appropriate

Reference:

  1. American College of Obstetricians and Gynecologists: Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 99:159-167, 2002.
  2. National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 183:S1-S22, 2000.

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