J Korean Soc Matern Child Health.  2023 Jul;27(3):140-147. 10.21896/jksmch.2023.27.3.140.

Current Treatment Guidelines and Antihypertensive Therapy of Mild Chronic Hypertension During Pregnancy

Affiliations
  • 1Department of Obstetrics and Gynecology, Kangwon National University School of Medicine, Chuncheon, Korea

Abstract

Up to 5% of pregnant females experience chronic hypertension, which is linked to poor pregnancy outcomes, and along with hemorrhage, is considered one of the main causes of maternal morbidity and mortality. The combined occurrence of preeclampsia, cesarean sections, preterm birth, birth weight less than 2,500 g, neonatal unit admission, and perinatal death was higher in females with chronic hypertension. Pregnancy with systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-109 mmHg was considered to have mild-to-moderate chronic hypertension. Blood pressure management during pregnancy is a very important issue and is directly related to fetal growth and maternal health. Many studies have reported that antihypertensive therapy during pregnancy halves the incidence of severe hypertension in all types of hypertensive diseases. However, guidelines for optimal blood pressure management goals during pregnancy remain unclear. This is because the benefits to the mother from lowering blood pressure are uncertain, and there is a risk of fetal disorders due to the possibility of reduced uteroplacental blood flow. In light of a recently released CHAP (Chronic Hypertension and Pregnancy) randomized controlled trial, the purpose of this review was to provide a summary of the current recommendations for pregnant females with mild-to-moderate chronic hypertension.

Keyword

Antihypertensive therapy, Chronic hypertension, Chronic hypertension and pregnancy, Hypertensive disorder of pregnancy, Preeclampsia

Reference

Abalos E., Duley L., Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Data base Syst Rev. 2014. 2:CD002252.
Article
Abalos E., Duley L., Steyn DW., Gialdini C. Antihypertensive drug the rapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2018. 10:CD002252.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy. Obstet Gynecol. 2019. 133:e26–50.
American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013. 122:1122–31.
Brown MA., Magee LA., Kenny LC., Karumanchi SA., McCarthy FP., Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018. 72:24–43.
Butalia S., Audibert F., Côté AM., Firoz T., Logan AG., Magee LA, et al. Hypertension Canada's 2018 Guidelines for the management of hypertension in pregnancy. Can J Cardiol. 2018. 34:526–31.
Article
Chiriacò M., Pateras K., Virdis A., Charakida M., Kyriakopoulou D., Nannipieri M, et al. Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2019. 21:2587–98.
Article
Choi YJ., Kim SH., Kang SH., Yoon CH., Lee HY., Youn TJ, et al. Recon-sidering the cut-off diastolic blood pressure for predicting cardiovascular events: a nationwide population-based study from Korea. Eur Heart J. 2019. 40:724–31.
Article
Churchill D., Beevers GD., Meher S., Rhodes C. Diuretics for preventing preeclampsia. Cochrane Database Syst Rev. 2007. 2007:CD004451.
Article
Clark SL., Hankins GD. Preventing maternal death: 10 clinical diamonds. Obstet Gynecol. 2012. 119(2 Pt 1):360–4.
Collins R., Yusuf S., Peto R. Overview of randomised trials of diuretics in pregnancy. Br Med J (Clin Res Ed). 1985. 290:17–23.
Article
Duley L., Meher S., Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev. 2013. 2013:CD001449.
Article
European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM)., Regitz-Zagrosek V., Blomstrom Lundqvist C., Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011. 32:3147–97.
Fitton CA., Steiner MFC., Aucott L., Pell JP., Mackay DF., Fleming M, et al. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens. 2017. 35:2123–37.
Gruppo di Studio Ipertensione in Gravidanza. Nifedipine versus expectant management in mild to moderate hypertension in pregnancy. Br J Obstet Gynaecol. 1998. 105:718–22.
Lewington S., Clarke R., Qizilbash N., Peto R., Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002. 360:1903–13.
Article
Lopes Perdigao J., Lewey J., Hirshberg A., Koelper N., Srinivas SK., Elovitz MA, et al. Furosemide for accelerated recovery of blood pressure postpartum in women with a hypertensive disorder of pregnancy: a randomized controlled trial. Hypertension. 2021. 77:1517–24.
Article
Lydakis C., Lip GY., Beevers M., Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens. 1999. 12:541–7.
Article
Magee LA., Ornstein MP., von Dadelszen P. Fortnightly review: management of hypertension in pregnancy. BMJ. 1999. 318:1332–6.
Magee LA., von Dadelszen P., Rey E., Ross S., Asztalos E., Murphy KE, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015. 372:407–17.
Article
Magee LA., von Dadelszen P., Singer J., Lee T., Rey E., Ross S, et al. The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study): is severe hypertension just an elevated blood pressure? Hypertension. 2016. 68:1153–9.
Article
Moser M., Brown CM., Rose CH., Garovic VD. Hypertension in pregnancy: is it time for a new approach to treatment? J Hypertens. 2012. 30:1092–100.
National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management: NICE guideline [NG133] [Internet]. London: National Institute for Health and Care Excellence;2019. [updated 2023 Apr 7; cited 2019 Jul 29]. Available from: https://www.nice.org.uk/guidance/ng133/chapter/Recommendations#management-of-chronic-hypertension-in-pregnancy.
Pels A., Mol BWJ., Singer J., Lee T., von Dadelszen P., Ganzevoort W, et al. Influence of gestational age at initiation of antihypertensive therapy: secondary analysis of CHIPS trial data (Control of Hypertension in Pregnancy Study). Hypertension. 2018. 71:1170–7.
Sibai BM., Mabie WC., Shamsa F., Villar MA., Anderson GD. A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy. Am J Obstet Gynecol. 1990. 162:960–6. discussion. 966–7.
Article
Sinkey RG., Battarbee AN., Bello NA., Ives CW., Oparil S., Tita ATN. Prevention, diagnosis, and management of hypertensive disorders of pregnancy: a comparison of international guidelines. Curr Hypertens Rep. 2020. 22:66.
Article
SMFM Publications Committee. Electronic address: pubs@smfm.org. SMFM Statement: benefit of antihypertensive therapy for mild-to-moderate chronic hypertension during pregnancy remains uncertain. Am J Obstet Gynecol. 2015. 213:3–4.
Society for Maternal-Fetal Medicine; Publications Committee. Electronic address: pubs@smfm.org. Society for Maternal-Fetal Medicine Statement: antihypertensive therapy for mild chronic hypertension in pregnancy-The Chronic Hypertension and Pregnancy trial. Am J Obstet Gynecol. 2022. 227:B24–7.
Tita AT., Szychowski JM., Boggess K., Dugoff L., Sibai B., Lawrence K, et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med. 2022. 386:1781–92.
Article
von Dadelszen P., Ornstein MP., Bull SB., Logan AG., Koren G., Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet. 2000. 355:87–92.
Article
World Health Organization. WHO recommendations: drug treatment for severe hypertension in pregnancy [Internet]. Geneva (Switzer land): World Health Organization;2018. [cited 2023 Jul 21]. Available from: https://www.who.int/publications/i/item/9789241550437.
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