Treatment of hypertension during pregnancy appears to be safe and prevents maternal heart risk-ScienceDaily

The scientific statement is an analysis by current research experts and may be useful for future clinical practice guidelines. In this statement, experts in Preeclampsia: Diagnosis, Blood Pressure Targets, and Drug Therapy, Obstetrics and Gynecology, Maternal and Fetal Medicine, Cardiology, Nephrology, Preeclampsia, and Internal Medicine focus on hypertension during pregnancy. We reviewed and analyzed the quality studies we applied to include preeclampsia and preeclampsia / pre-eclampsia.

According to the latest American Heart Association statistics, hypertension during pregnancy, defined as systolic blood pressure above 140 mm Hg (the highest blood pressure measurement), is the second most common cause of maternal death in the world. In severe cases, the risk of cardiovascular complications in the mother is high immediately after or immediately after childbirth, and for several years after pregnancy. High blood pressure during pregnancy increases the risk of complications in offspring such as preterm birth, low birth weight infants, and low birth weight infants. The incidence of hypertension during pregnancy is increasing worldwide, and data affect disproportionately to women of diverse racial and ethnic backgrounds in the United States, especially blacks, Native Americans, or Alaska Native women. Indicates to give.

Treatment goals during pregnancy include prevention of severe hypertension and prevention of preterm birth to give the foetation time to mature before childbirth.

“For decades, the benefits of treating blood pressure for pregnant women were unclear, and there were concerns about fetal well-being from exposure to antihypertensive drugs,” said Besna D. Garovich, chair of the statement-writing group. The doctor of medicine said. , Professor of Medicine, Chairman of the Department of Kidney Disease and Hypertension, Co-appointed at the Mayo Clinic Obstetrics and Gynecology Department in Rochester, Minnesota. “Through a comprehensive review of existing literature, we see new evidence that the treatment of hypertension during pregnancy is safe and effective and may be beneficial at lower thresholds than previously thought. Reassuring. Pregnancy useful for optimal treatment and future research. “

Among the high-income countries, the United States has one of the highest maternal mortality rates associated with hypertension, according to the statement. Cardiovascular disease, including stroke and heart failure, currently accounts for up to half of maternal deaths in the United States, and hospitalization for pregnancy-related stroke increased by more than 60% between 1994 and 2011. Preeclampsia that occurs during high blood pressure during pregnancy According to the American Heart Association, with signs of liver and kidney problems such as protein in the urine, it affects 5% to 7% of pregnancies and affects 70,000 people worldwide each year. These are the causes of maternal death and 500,000 fetal deaths.

“Given the increasing number of cases of hypertension during pregnancy and hypertension-related complications, this problem has become a public health crisis, especially among women of racial and ethnically diverse backgrounds. “There is,” Garovich said.

The definition of hypertension in the general population is established at 130/80 mmHg according to the American College of Cardiology (ACC) / American Heart Association (AHA) Guidelines for Prevention, Detection, Assessment, and Management of Hypertension 2017. Adult blood pressure, most guidelines around the world define hypertension during pregnancy as 140/90 mmHg.

There is a lack of consensus on when to start hypertension treatment during pregnancy due to concerns about how the drug affects the foetation. Some health advocates recommend starting treatment when blood pressure measurements during pregnancy range from 140/90 mm Hg (Canadian guidelines) to 160/110 mm Hg (US guidelines).

The new statement provides evidence that hypotension therapy for preeclampsia significantly reduces the incidence of severe hypertension. Further research is needed to determine to some extent that treating hypertension at lower thresholds may reduce serious hypertension complications, ie, organ damage and hypertensive emergencies. Reducing severe hypertension may be especially important in communities that lack the resources and expertise to respond to hypertension emergencies, the authors write.

“Future studies need to consider whether lowering the threshold for treatment of hypertension during pregnancy enables safe and timely blood pressure control and avoids urgent childbirth due to uncontrolled hypertension. There is, “Garovic said.

So far, the latest research shows that treating high blood pressure during pregnancy with antihypertensive drugs does not adversely affect fetal growth or development. Preventing high blood pressure during pregnancy supports the health of the mother both during and after pregnancy. It is well known that people who suffer from high blood pressure during pregnancy are more likely to develop persistent hypertension after pregnancy than those who had normal blood pressure during pregnancy. This statement reinforces recent studies suggesting that lifestyle changes before and during pregnancy may improve maternal and fetal outcomes.

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

This statement also focuses on these concerns.

• There is new evidence that postnatal (postnatal) hypertension may be associated with serious maternal health problems.
• Current science suggests that physicians need to personalize treatment decisions by considering risk factors and patient preferences.
• Care for women with hypertension during pregnancy is often complex and a multi-specialized team of medical professionals may be beneficial.

“Future clinical trials are needed to address the question of when to start treatment for high blood pressure during pregnancy,” Garovic said. “Also, close collaboration between the American Heart Association and the American Society of Obstetrics and Gynecology optimizes the diagnosis and treatment of hypertension during pregnancy and improves immediate and long-term outcomes for many women who develop hypertension during pregnancy. It helps. “