Review Question - QID 103369

The patient has mild to moderate hypertension (BP 140-159 / 90-109 mm Hg). Current evidence and standard of care does not support the use of blood pressure lowering medication in pregnant women with mild to moderate hypertension.

Gestational hypertension is defined as hypertension in the 2nd half of pregnancy without proteinuria. Gestational hypertension may progress to preeclampsia, may persist post-partum as chronic hypertension, or may normalize spontaneously postpartum.

Leeman et al. discuss hypertensive disorders of pregnancy. Elevated blood pressures recorded before 20 weeks gestation are indicative of chronic hypertension. Maternal end-organ function can be compromised when blood pressures increase to 150-180/110-110 mmHg and treatment is warranted to prevent end-organ damage. Neonatal outcomes are not improved with treatment of mild to moderate hypertension in pregnancy and there is no data suggesting a decreased risk of preeclampsia by pharmacological intervention for blood pressure in the mild to moderately elevated range.

Abalos et al., in a 2007 Cochrane Review of 46 trials, found insufficient evidence to support the use of blood pressure lowering medications in pregnant women with mild to moderate hypertension.

Illustration A depicts the pathogenesis of preeclampsia. In preeclampsia, placental ischemia secondary to impaired vasodilation of spiral arteries results in increased vascular tone.

Incorrect Answers:
Answer 1 and 2: IV Hydralazine and labetolol are the preferred agents for the treatment of acute hypertension in pregnancy.
Answer 3: Methyldopa is an oral antihypertensive agent safe for use in pregnancy with a relatively slow onset of action.
Answer 4: ACE inhibitors such as lisinopril are contraindicated in pregnancy.