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Chronic Hypertension in Pregnancy EllenW. Seely, MD; Cynthia Maxwell, MD M any women have been diagnosed with hypertension (blood pressure 140/ 90 mmHg) when they were in their … M any women have been diagnosed with hypertension (blood pressure 140/ 90 mmHg) when they were in their childbearing years. Because the hypertension predates the pregnancy, it is called chronic hypertension. This type of hypertension complicates at least 5%of all pregnancies. When managed appropriately, most women with chronic hy- pertensioncan experience healthy pregnancies and give birth to healthy babies. To accomplish this goal, it is important that women with chronic hypertension let their doctors know when they are planninga pregnancy so that they can receive pregnancy counseling and so that adjustments to antihypertensive medications can be made if needed.

TABLE1. Types of Hypertension in Pregnant Women Chronic hypertension: hypertension predates pregnancy Essential hypertension Secondary hypertension Hypertension induced by pregnancy: hypertension first becomes manifest during pregnancy… posed preeclampsia that is causing damage to organs in your body, your doctor may recommend early delivery. Early delivery is associated with prematurity. If an early delivery is planned, your body may not be ready to deliver the baby vaginally, so there is a greater chance that you might need a cesarean section. Hypertension may also affect the development of the placenta, which is important for the nourishment and growth of the fetus. Thus, some babies maybe affected by low amniotic fluid levels and/or intrauterine growth restriction (Table 3). Should ITakeMy Blood Pressure Medications During Pregnancy? Some medications should not betaken during pregnancy, and your doctor may need to change your medications before you become pregnant. When you are not pregnant, your blood pressure medications affect only you, but when you are pregnant, these medica- tionsmaycrossthe placenta and affect your fetus. We do not know defini- tivelywhichblood pressure medica- tionsshouldbe used in pregnancy, so we generally use the ones that have been used for the longest amount of time in many pregnant women without serious problems (Table 4).1,3 There are some medication classes that we do not use in pregnant women. Angiotensin-converting enzyme inhib- itorsarevery commonly used to treat chronic hypertension. This drug class can cause problems in the fetus, in- cludingan increased risk of birth de- fects4 andkidney failure. Angiotensin II receptorblockers also should be avoided in pregnancy because they have many effects similar to those of angiotensin-converting enzyme inhibitors and their use in pregnancy has been associated with renal failure in the fetus. Aldosterone receptor blockers should be avoided until more infor mationis available. If you are on a medication in these classes, it is im- portantthatyou see your doctor before becoming pregnant so that your medication can be changed. How LowShould My Blood Pressure Runin Pregnancy? Outside of pregnancy, blood pressure goals for nondiabetic women are 140/90 mmHg. This goal is chosen to help prevent the complications of hypertension such as heart attacks and strokes. In pregnancy, the goal for your blood pressure maybe loosened because it is important for the fetus to receive enough blood flow. Furthermore, because pregnancy is only 9 months, concern at that time is less focused on thelong term complicationsof hypertension. Your doctor will discuss with you blood pressure goals for pregnancy….. TABLE2. Complications of Chronic Hypertension in Pregnancy Pregnancy-aggravated hypertension Superimposed preeclampsia Placental abruption…

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