Hypertension in Pregnancy: Natural History and Treatment Options

Overview

Journal Curr Hypertens Rep

Specialty Cardiology & Vascular Diseases

Date 2015 Apr 3

PMID 25833457

Citations 13

Authors

L Foo

J Tay

C C Lees

C M McEniery

I B Wilkinson

Affiliations

Soon will be listed here.

Abstract

Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored.

Citing Articles

A Case Report of Pediatric Rehabilitation for Hypoxic Ischemic Encephalopathy Associated With Global Developmental Delay.

Ankar P, Sharath H, Chavan N Cureus. 2024; 16(2):e54851.

PMID: 38533149 PMC: 10964207. DOI: 10.7759/cureus.54851.

Comparing Intravenous Labetalol and Intravenous Hydralazine for Managing Severe Gestational Hypertension.

Ehikioya E, Okobi O, Beeko M, Abanga R, Abah N, Briggs L Cureus. 2023; 15(7):e42332.

PMID: 37614273 PMC: 10443893. DOI: 10.7759/cureus.42332.

Antihypertensive medication use during pregnancy in a real-world cohort of patients diagnosed with a hypertensive disorder of pregnancy.

Garcia J, Mulrenin I, Nguyen A, Loop M, Daubert M, Urrutia R Front Cardiovasc Med. 2023; 10:1225251.

PMID: 37485273 PMC: 10360165. DOI: 10.3389/fcvm.2023.1225251.

Influenza Virus Infection during Pregnancy as a Trigger of Acute and Chronic Complications.

Oseghale O, Vlahos R, OLeary J, Brooks R, Brooks D, Liong S Viruses. 2022; 14(12).

PMID: 36560733 PMC: 9786233. DOI: 10.3390/v14122729.

The Impact of Pregnancy on Antihypertensive Drug Metabolism and Pharmacokinetics: Current Status and Future Directions.

Mulrenin I, Garcia J, Fashe M, Loop M, Daubert M, Urrutia R Expert Opin Drug Metab Toxicol. 2021; 17(11):1261-1279.

PMID: 34739303 PMC: 8743049. DOI: 10.1080/17425255.2021.2002845.

References

Lees C, Valensise H, Black R, Harrington K, Byiers S, Romanini C . The efficacy and fetal-maternal cardiovascular effects of transdermal glyceryl trinitrate in the prophylaxis of pre-eclampsia and its complications: a randomized double-blind placebo-controlled trial. Ultrasound Obstet Gynecol. 1998; 12(5):334-8. DOI: 10.1046/j.1469-0705.1998.12050334.x. View

Conde-Agudelo A, Romero R, Kusanovic J, Hassan S . Supplementation with vitamins C and E during pregnancy for the prevention of preeclampsia and other adverse maternal and perinatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011; 204(6):503.e1-12. PMC: 3380625. DOI: 10.1016/j.ajog.2011.02.020. View

Foo L, Bewley S, Rudd A . Maternal death from stroke: a thirty year national retrospective review. Eur J Obstet Gynecol Reprod Biol. 2013; 171(2):266-70. DOI: 10.1016/j.ejogrb.2013.09.021. View

Verlohren S, Melchiorre K, Khalil A, Thilaganathan B . Uterine artery Doppler, birth weight and timing of onset of pre-eclampsia: providing insights into the dual etiology of late-onset pre-eclampsia. Ultrasound Obstet Gynecol. 2014; 44(3):293-8. DOI: 10.1002/uog.13310. View

Brown M, Gallery E . Volume homeostasis in normal pregnancy and pre-eclampsia: physiology and clinical implications. Baillieres Clin Obstet Gynaecol. 1994; 8(2):287-310. DOI: 10.1016/s0950-3552(05)80322-0. View

Schroeder B . ACOG practice bulletin on diagnosing and managing preeclampsia and eclampsia. American College of Obstetricians and Gynecologists. Am Fam Physician. 2002; 66(2):330-1. View

Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D . 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. 2011; 118 Suppl 1:1-203. DOI: 10.1111/j.1471-0528.2010.02847.x. View

Lees C, Parra M, Missfelder-Lobos H, Morgans A, Fletcher O, Nicolaides K . Individualized risk assessment for adverse pregnancy outcome by uterine artery Doppler at 23 weeks. Obstet Gynecol. 2001; 98(3):369-73. DOI: 10.1016/s0029-7844(01)01474-0. View

Chung E, Leinwand L . Pregnancy as a cardiac stress model. Cardiovasc Res. 2014; 101(4):561-70. PMC: 3941597. DOI: 10.1093/cvr/cvu013. View

10.

Melchiorre K, Sutherland G, Liberati M, Thilaganathan B . Preeclampsia is associated with persistent postpartum cardiovascular impairment. Hypertension. 2011; 58(4):709-15. DOI: 10.1161/HYPERTENSIONAHA.111.176537. View

11.

Rumbold A, Crowther C, Haslam R, Dekker G, Robinson J . Vitamins C and E and the risks of preeclampsia and perinatal complications. N Engl J Med. 2006; 354(17):1796-806. DOI: 10.1056/NEJMoa054186. View

12.

Scott Jr W, Resnick E, Hummler H, Clozel J, Burgin H . Cardiovascular alterations in rat fetuses exposed to calcium channel blockers. Reprod Toxicol. 1997; 11(2-3):207-14. DOI: 10.1016/s0890-6238(97)00008-7. View

13.

Melchiorre K, Sutherland G, Liberati M, Thilaganathan B . Maternal cardiovascular impairment in pregnancies complicated by severe fetal growth restriction. Hypertension. 2012; 60(2):437-43. DOI: 10.1161/HYPERTENSIONAHA.112.194159. View

14.

Banerjee S, Chambers A, Campbell S . Is vitamin E a safe prophylaxis for preeclampsia?. Am J Obstet Gynecol. 2006; 194(5):1228-33. DOI: 10.1016/j.ajog.2005.11.034. View

15.

Khalil A, Akolekar R, Syngelaki A, Elkhouli M, Nicolaides K . Maternal hemodynamics at 11-13 weeks' gestation and risk of pre-eclampsia. Ultrasound Obstet Gynecol. 2012; 40(1):28-34. DOI: 10.1002/uog.11183. View

16.

van Rijn B, Nijdam M, Bruinse H, Roest M, Uiterwaal C, Grobbee D . Cardiovascular disease risk factors in women with a history of early-onset preeclampsia. Obstet Gynecol. 2013; 121(5):1040-1048. DOI: 10.1097/AOG.0b013e31828ea3b5. View

17.

Romero R, Garite T . Unexpected results of an important trial of vitamins C and E administration to prevent preeclampsia. Am J Obstet Gynecol. 2006; 194(5):1213-4. DOI: 10.1016/j.ajog.2006.04.007. View

18.

Cindrova-Davies T . The therapeutic potential of antioxidants, ER chaperones, NO and H2S donors, and statins for treatment of preeclampsia. Front Pharmacol. 2014; 5:119. PMC: 4034700. DOI: 10.3389/fphar.2014.00119. View

19.

Kumasawa K, Ikawa M, Kidoya H, Hasuwa H, Saito-Fujita T, Morioka Y . Pravastatin induces placental growth factor (PGF) and ameliorates preeclampsia in a mouse model. Proc Natl Acad Sci U S A. 2010; 108(4):1451-5. PMC: 3029692. DOI: 10.1073/pnas.1011293108. View

20.

Fujime M, Tomimatsu T, Okaue Y, Koyama S, Kanagawa T, Taniguchi T . Central aortic blood pressure and augmentation index during normal pregnancy. Hypertens Res. 2012; 35(6):633-8. DOI: 10.1038/hr.2012.1. View