Skip to main content

Advertisement

SpringerLink
Log in

Treating Hypertension in Pregnancy

  • Novel Treatments for Hypertension (T Unger, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Hypertension is present in about 10 % of all pregnancies. The frequency of chronic hypertension and that of gestational hypertension is increasing. The management of pregnant women with hypertension remains a significant, but controversial, public health problem. Although treatment of hypertension in pregnancy has shown to reduce maternal target organ damage, considerable debate remains concerning treatment. We review current evidence regarding treatment goals, the ideal treatment starting time, and which drugs are available for the treatment of hypertension in pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med. 2011;365:439–46. Comprehensive review which summarizes the uncertainties when to initiate treatment.

    Article  CAS  PubMed  Google Scholar 

  2. American College of O, Gynecologists, Task Force on Hypertension in P. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122–31.

    Article  Google Scholar 

  3. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376:631–44. Outstanding review about pathophysiology and treatment of preeclampsia.

    Article  PubMed  Google Scholar 

  4. Solomon CG, Greene MF. Control of hypertension in pregnancy—if some is good, is more worse? N Engl J Med. 2015;372:475–6. Excellent comment on advantages.

    Article  CAS  PubMed  Google Scholar 

  5. Catov JM, Nohr EA, Olsen J, Ness RB. Chronic hypertension related to risk for preterm and term small for gestational age births. Obstet Gynecol. 2008;112:290–6.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sibai BM, Lindheimer M, Hauth J, et al. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 1998;339:667–71.

    Article  CAS  PubMed  Google Scholar 

  7. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case–control study. BMJ. 2001;322:1089–93. discussion 93-4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Duley L, Meher S, Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev. 2013;7:CD001449

  9. Lambert G, Brichant JF, Hartstein G, Bonhomme V, Dewandre PY. Preeclampsia: an update. Acta Anaesthesiol Belg. 2014;65:137–49.

    CAS  PubMed  Google Scholar 

  10. Wilkinson H, Trustees, Medical A. Saving mothers’ lives. Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG Int J Obstet Gynaecol. 2011;118:1402–3. discussion 3-4.

    Article  Google Scholar 

  11. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–74.

    Article  PubMed  Google Scholar 

  12. Hypertension in pregnancy. The management of hypertensive disorders during pregnancy. London; 2010.

  13. Easterling TR. Pharmacological management of hypertension in pregnancy. Semin Perinatol. 2014;38:487–95. Comprehensive and excellent review of treatment choices in pregnancy.

    Article  PubMed  Google Scholar 

  14. Al Khaja KA, Sequeira RP, Alkhaja AK, Damanhori AH. Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations. J Hypertens. 2014;32:454–63.

    Article  CAS  PubMed  Google Scholar 

  15. Too GT, Hill JB. Hypertensive crisis during pregnancy and postpartum period. Semin Perinatol. 2013;37:280–7.

    Article  PubMed  Google Scholar 

  16. Martin Jr JN, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105:246–54.

    Article  PubMed  Google Scholar 

  17. Magee LA, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372:407–17. Seminal randomized clinical trial which examines two strategies of antihypertensive treatment in pregnancy.

    Article  CAS  PubMed  Google Scholar 

  18. Magee LA, Dadelszen P, Rey E, et al. [59-OR]: the control of hypertension in pregnancy study (CHIPS) randomized controlled trial—is the type of antihypertensive important? Pregnancy Hypertens. 2015;5:30–1.

    PubMed  Google Scholar 

  19. Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol. 2002;100:369–77.

    Article  PubMed  Google Scholar 

  20. Vest AR, Cho LS. Hypertension in pregnancy. Curr Atheroscler Rep. 2014;16:395.

    Article  PubMed  Google Scholar 

  21. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007;CD002252.

  22. Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2014;2:CD002252.

  23. 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  Google Scholar 

  24. Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG Int J Obstet Gynaecol. 2011;118 Suppl 1:1–203.

    Google Scholar 

  25. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension. 2008;51:960–9.

    Article  CAS  PubMed  Google Scholar 

  28. Cifkova R. Why is the treatment of hypertension in pregnancy still so difficult? Expert Rev Cardiovasc Ther. 2011;9:647–9.

    Article  PubMed  Google Scholar 

  29. Ghanem FA, Movahed A. Use of antihypertensive drugs during pregnancy and lactation. Cardiovasc Ther. 2008;26:38–49. Brilliant summary of the antihyertensive treatment options.

    CAS  PubMed  Google Scholar 

  30. Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med. 1996;335:257–65.

    Article  CAS  PubMed  Google Scholar 

  31. Montan S, Anandakumar C, Arulkumaran S, Ingemarsson I, Ratnam SS. Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension. Am J Obstet Gynecol. 1993;168:152–6.

    Article  CAS  PubMed  Google Scholar 

  32. Khalil A, Harrington K, Muttukrishna S, Jauniaux E. Effect of antihypertensive therapy with alpha-methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2010;35:688–94.

    CAS  Google Scholar 

  33. Redman CW, Beilin LJ, Bonnar J. Treatment of hypertension in pregnancy with methyldopa: blood pressure control and side effects. Br J Obstet Gynaecol. 1977;84:419–26.

    Article  CAS  PubMed  Google Scholar 

  34. Kattah AG, Garovic VD. The management of hypertension in pregnancy. Adv Chronic Kidney Dis. 2013;20:229–39.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Magee LA, Elran E, Bull SB, Logan A, Koren G. Risks and benefits of beta-receptor blockers for pregnancy hypertension: overview of the randomized trials. Eur J Obstet Gynecol Reprod Biol. 2000;88:15–26.

    Article  CAS  PubMed  Google Scholar 

  36. Waterman EJ, Magee LA, Lim KI, Skoll A, Rurak D, von Dadelszen P. Do commonly used oral antihypertensives alter fetal or neonatal heart rate characteristics? A systematic review. Hypertens Pregnancy. 2004;23:155–69.

    Article  CAS  PubMed  Google Scholar 

  37. Magee LA, Duley L. Oral beta-blockers for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2003;CD002863.

  38. Sandstrom B. Antihypertensive treatment with the adrenergic beta-receptor blocker metoprolol during pregnancy. Gynecol Investig. 1978;9:195–204.

    Article  CAS  Google Scholar 

  39. Oumachigui A, Verghese M, Balachander J. A comparative evaluation of metoprolol and methyldopa in the management of pregnancy induced hypertension. Indian Heart J. 1992;44:39–41.

    CAS  PubMed  Google Scholar 

  40. Lunell NO, Fredholm B, Hjemdahl P, et al. Labetalol, a combined alpha- and beta-blocker, in hypertension of pregnancy. Acta Med Scand Suppl. 1982;665:143–7.

    CAS  PubMed  Google Scholar 

  41. Tranquilli AL, Giannubilo SR. Use and safety of calcium channel blockers in obstetrics. Curr Med Chem. 2009;16:3330–40.

    Article  CAS  PubMed  Google Scholar 

  42. Jayawardana J, Lekamge N. A comparison of nifedipine with methyldopa in pregnancy induced hypertension. Ceylon Med J. 1994;39:87–90.

    CAS  PubMed  Google Scholar 

  43. Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003;327:955–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Collins R, Yusuf S, Peto R. Overview of randomised trials of diuretics in pregnancy. Br Med J. 1985;290:17–23.

    Article  CAS  Google Scholar 

  45. Churchill D, Beevers GD, Meher S, Rhodes C. Diuretics for preventing pre-eclampsia. Cochrane Database Syst Rev. 2007;CD004451.

  46. Martinovic J, Benachi A, Laurent N, Daikha-Dahmane F, Gubler MC. Fetal toxic effects and angiotensin-II-receptor antagonists. Lancet. 2001;358:241–2.

    Article  CAS  PubMed  Google Scholar 

  47. Lasaitiene D, Chen Y, Adams MA, Friberg P. Further insights into the role of angiotensin II in kidney development. Clin Physiol Funct Imaging. 2006;26:197–204.

    Article  CAS  PubMed  Google Scholar 

  48. Vadhera RB, Simon M. Hypertensive emergencies in pregnancy. Clin Obstet Gynecol. 2014;57:797–805.

    Article  PubMed  Google Scholar 

  49. Committee on Obstetric P. Committee Opinion no. 514: emergent therapy for acute-onset, severe hypertension with preeclampsia or eclampsia. Obstet Gynecol. 2011;118:1465–8.

    Article  Google Scholar 

  50. Wacker JR, Wagner BK, Briese V, et al. Antihypertensive therapy in patients with pre-eclampsia: a prospective randomised multicentre study comparing dihydralazine with urapidil. Eur J Obstet Gynecol Reprod Biol. 2006;127:160–5.

    Article  CAS  PubMed  Google Scholar 

  51. Magee LA, Abalos E, von Dadelszen P, et al. How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol. 2011;72:394–401.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. McClure CK, Catov JM, Ness RB, Schwarz EB. Lactation and maternal subclinical cardiovascular disease among premenopausal women. Am J Obstet Gynecol. 2012;207:46 e1-8.

    Article  PubMed  Google Scholar 

  53. Stuebe AM, Schwarz EB, Grewen K, et al. Duration of lactation and incidence of maternal hypertension: a longitudinal cohort study. Am J Epidemiol. 2011;174:1147–58.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy. 2002;21:85–95.

    Article  CAS  PubMed  Google Scholar 

  55. Magee L, von Dadelszen P. Prevention and treatment of postpartum hypertension. Cochrane Database Syst Rev. 2013;4:CD004351.

  56. Shannon ME, Malecha SE, Cha AJ. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and lactation: an update. J Human Lact Off J Int Lact Consult Assoc. 2000;16:152–5.

    Article  CAS  Google Scholar 

  57. American Academy of Pediatrics Committee on D. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776–89.

    Google Scholar 

  58. Bramham K, Nelson-Piercy C, Brown MJ, Chappell LC. Postpartum management of hypertension. BMJ. 2013;346:f894. Comprehensive review of antihypertensive management postpartum.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dietmar Schlembach, Volker Homuth, and Ralf Dechend declare no conflicts of interest.

Human and Animal Rights and Informed Consent

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

Author information

Authors and Affiliations

  1. Department of Obstetrics, Klinikum Neukölln, Vivantes, Berlin, Germany

    Dietmar Schlembach

  2. HELIOS Klinikum-Berlin and Experimental and Clinical Research Center, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Volker Homuth & Ralf Dechend

  3. Experimental and Clinical Research Center, a joint cooperation between the Max-Delbrück Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany

    Ralf Dechend

Authors
  1. Dietmar Schlembach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Volker Homuth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ralf Dechend
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ralf Dechend.

Additional information

This article is part of the Topical Collection on Novel Treatments for Hypertension

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schlembach, D., Homuth, V. & Dechend, R. Treating Hypertension in Pregnancy. Curr Hypertens Rep 17, 63 (2015). https://doi.org/10.1007/s11906-015-0572-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-015-0572-y

Keywords

Search

Navigation