women s health issues
High Blood Pressure During Pregnancy
Treatment of High Blood Pressure During Pregnancy
For mild to moderate high blood pressure, reduced activity and, if needed, antihypertensive medications For more severe high blood pressure, antihypertensive medications Avoidance of certain antihypertensive medications Medications may or may not be used, depending on how high blood pressure is and how well the kidneys are functioning. Use and choice of medications to treat chronic and gestational hypertension are similar. However, gestational hypertension often occurs late in pregnancy and does not require treatment with medications. Formild to moderate high blood pressure(140/90 to 159/109 millimeters of mercury [mm Hg]), treatment depends on many factors. Doctors may recommend reducing physical activity to possibly help lower blood pressure. If reduced activity does not lower blood pressure, many experts recommend treatment with antihypertensive medications. Whether the benefits of these medications outweigh the risks is unclear. However, if the kidneys are not functioning normally, medications are needed. If high blood pressure is not controlled well, the kidneys may be damaged further. ). Treatment can reduce the risk of stroke and other Complications of high blood pressure . Forvery high blood pressure(180/110 mm Hg or higher), women are evaluated immediately because risk of complications for women and/or the fetus is high. If women wish to continue the pregnancy despite the risk, they often require several antihypertensive medications. They may be hospitalized toward the end of the pregnancy. If their condition worsens, doctors may recommend ending the pregnancy. Women are taught to check their blood pressure at home. Doctors periodically do tests to determine how well the kidneys and liver are functioning and do ultrasonography to determine how well the fetus is growing. If pregnant women have moderately high to very high blood pressure, the baby is typically delivered at 37 to 39 weeks. It is delivered earlier if the fetus is growing slowly, the fetus is having problems, or the woman has severe preeclampsia. Antihypertensive Drugs None Methyldopa Beta-blockers (most commonly,labetalol) Calcium channel blockers (such asnifedipine) However, angiotensin-converting enzyme (ACE) inhibitors are stopped during pregnancy, particularly during the last two trimesters. These medications can cause birth defects of the urinary tract in the fetus. As a result, the baby may die shortly after birth. Angiotensin IIreceptor blockers are stopped because they increase the risk of kidney, lung, and skeletal problems and death in the fetus. Aldosterone antagonists (spironolactoneandeplerenone) are also stopped because they can cause a male fetus to develop feminine characteristics. Some medications used to treat high blood pressure and heart disorders—ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and often thiazide diuretics—are usually stopped during pregnancy. Thiazide diuretics are usually stopped because they can cause low potassium levels in the fetus. However, if other medications are ineffective or have intolerable side effects, women with chronic hypertension may be given thiazide diuretics (such ashydrochlorothiazide) during pregnancy. 