Treatment of high blood pressure in pregnancy appears safe and reduces maternal risk


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Treating high blood pressure during pregnancy appears safe for many women and may reduce maternal risk of severe hypertension without increasing fetal and newborn risks, according to a new scientific statement from the American Heart Association released today in the Association’s journal Hypertension.

A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines. In this statement, “Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals and Drug Therapy,” experts in obstetrics and gynecology, maternal and fetal medicine, cardiology, nephrology, hypertension and internal medicine reviewed and reviewed quality studies focusing on high blood pressure in pregnancy. including gestational hypertension and preeclampsia / eclampsia.

The latest statistics from the American Heart Association indicate that hypertension in pregnancy, defined as a systolic pressure (the highest number in a blood pressure reading) of 140 mm Hg or more, is the second leading cause of death mother in the world. Severe cases are associated with increased risks of cardiovascular complications for mothers immediately or soon after childbirth and for years after pregnancy.

High blood pressure during pregnancy increased the risk of complications for the offspring such as premature labor, small for gestational age, and low birth weight. Rates of hypertension during pregnancy are on the rise globally, and data indicates that it disproportionately affects women of diverse racial and ethnic backgrounds in the United States, especially those who are Black, Native American, or Native American. Alaska.

The goals of treatment during pregnancy include prevention of severe high blood pressure and prevention of early delivery to allow the fetus to mature before delivery.

“For decades, the benefits of treating high blood pressure for pregnant women were unclear. And the fetal well-being associated with exposure to antihypertensive drugs has raised concerns,” said the group’s chairperson. statement writing, Vesna D. Garovic, MD, Ph.D., professor of medicine, chair of the division of nephrology and hypertension with a joint appointment in the department of obstetrics and gynecology at the Mayo Clinic in Rochester, Minnesota. “From our comprehensive review of the existing literature, it is reassuring to see evidence emerging that the treatment of high blood pressure in pregnancy is safe and effective and may be of benefit at lower thresholds than previously thought. Now, we have the current statement focused on hypertension in pregnancy to help inform optimal treatment and future research.

According to the release, among high-income countries, the United States has one of the highest maternal mortality rates from hypertension. Cardiovascular disease, which includes stroke and heart failure, now accounts for up to half of all maternal deaths in the United States, and pregnancy-related stroke hospitalizations have increased by more than 60% between 1994 and 2011.

Preeclampsia, which occurs when high blood pressure during pregnancy is accompanied by signs of liver or kidney problems such as protein in the urine, affects 5-7% of pregnancies and is responsible for over 70,000 maternal deaths and 500,000 fetal deaths worldwide each year, according to the American Heart Association.

With the increasing number of cases of hypertension during pregnancy, as well as the complications of hypertension, the problem has become a public health crisis, especially among women of diverse racial and ethnic backgrounds.. “

Vesna D. Garovic, MD, Ph.D., professor of medicine, chair of the division of nephrology and hypertension with a joint appointment in the department of obstetrics and gynecology, Mayo Clinic

While the definition of hypertension for the general population is set at 130/80 mm Hg according to the 2017 American College of Cardiology (ACC) / American Heart Association (AHA) guideline for the prevention, detection, Assessment and Management of Hypertension Pressure in adults, most guidelines around the world define hypertension in pregnancy as 140/90 mm Hg.

There is no consensus on when to start treatment for hypertension during pregnancy due to concerns about the impact of the drugs on the fetus. Several health advocacy groups recommend starting treatment when blood pressure readings during pregnancy are between 140/90 mm Hg (Canadian guidelines) and 160/110 mm Hg (US guidelines).

The new statement highlights that hypotensive therapy for hypertension in pregnancy significantly reduces the incidence of severe hypertension. More research is needed to determine to what extent treating hypertension at a lower threshold can reduce serious hypertensive complications, namely organ damage and hypertensive emergencies. Reducing severe hypertension may be especially important in communities that lack the resources and expertise to respond to hypertension-related emergencies, the authors of the statement write.

“Future studies should determine whether lowering the threshold for treating hypertension in pregnancy could allow safe and rapid control of blood pressure and prevent rushed delivery due to uncontrolled hypertension,” Garovic said. .

So far, the latest research indicates that treating hypertension during pregnancy with hypotensive drugs does not appear to have a negative impact on the growth or development of the fetus. Preventing hypertension during pregnancy promotes maternal health during and after pregnancy. It is well known that those with hypertension during pregnancy are more likely to develop sustained hypertension after pregnancy at a higher rate than those with normal blood pressure during pregnancy. The statement bolsters recent research which suggests that lifestyle changes before and during pregnancy have the potential to improve maternal and fetal outcomes:

  • Dietary changes before and during pregnancy can limit weight gain and improve pregnancy outcomes.
  • Exercise during pregnancy can reduce the risk of gestational hypertension by about 30% and the risk of preeclampsia by about 40%.

The statement also highlights these areas of concern:

  • New evidence shows that postpartum (postpartum) high blood pressure may be associated with important maternal health problems.
  • Current science suggests that physicians should individualize treatment decisions, taking into account risk factors and patient preferences.
  • The care of women with hypertension during pregnancy is often complex, and a multi-specialist team of health professionals can be beneficial.

“Future clinical trials are needed to answer questions about when to start treatment for high blood pressure during pregnancy,” Garovic said. “In addition, close collaboration between the American Heart Association and the American College of Obstetricians and Gynecologists will be instrumental in optimizing the diagnosis and treatment of hypertension in pregnancy and in improving immediate and long-term outcomes for de many women who develop hypertension during pregnancy. “

Source:

Journal reference:

Garovic, VD, et al. (2021) Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Drug Therapy: A Scientific Statement from the American Heart Association. Hypertension. doi.org/10.1161/HYP.000000000000208.

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