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Resistant Hypertension in Pregnancy: How to Manage?

  • Resistant Hypertension (L Drager, Section Editor)
  • Published:
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Abstract

Purpose of Review

The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium.

Recent Findings

The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum.

Summary

The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother’s risk. Good care is mandatory to reduce maternal mortality risk.

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Author information

Authors and Affiliations

  1. Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil

    Maria Rita Bortolotto

  2. Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil

    Rossana Pulcineli Vieira Francisco & Marcelo Zugaib

Authors
  1. Maria Rita Bortolotto
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  2. Rossana Pulcineli Vieira Francisco
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  3. Marcelo Zugaib
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Correspondence to Maria Rita Bortolotto.

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The authors declare no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Resistant Hypertension

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Bortolotto, M.R., Francisco, R.P.V. & Zugaib, M. Resistant Hypertension in Pregnancy: How to Manage?. Curr Hypertens Rep 20, 63 (2018). https://doi.org/10.1007/s11906-018-0865-z

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  • DOI: https://doi.org/10.1007/s11906-018-0865-z

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