Control of hypertension in pregnancy (original) (raw)
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The Control of Hypertension In Pregnancy Study pilot trial
BJOG: An International Journal of Obstetrics & Gynaecology, 2007
Objective To determine whether 'less tight' (versus 'tight') control of nonsevere hypertension results in a difference in diastolic blood pressure (dBP) between groups.
Management of hypertension in pregnancy: prevention, diagnosis, treatment and long‑term prognosis
Kardiologia Polska, 2019
of hypertension in pregnancy 757 to 10% of pregnancies in the United States and Europe. Women with chronic HT (1%-5% of the general population) have a higher risk of PE than women without pre existing HT (17%-25% vs 3%-5%, respectively). Furthermore, 7% to 20% of women with chronic HT have poor BP control in pregnancy (excluding those with PE). Significantly elevated BP in pregnancy is a di rect threat to maternal and fetal health and life. According to the World Health Organization (WHO), HT and its complications are among the leading causes of mortality in pregnancy in developed countries (approx. 16%). 9-11 HT promotes low birth weight (LBW), increas es the risk of PE superimposed on chronic HT and preterm birth, may cause placental abrup tion, leads to complications which require pro longed intensive care of a neonate with special ist neonatal treatment, and may cause intrauter ine fetal death. 12,13 PE is the most dangerous maternal complica tion of HT. PE is associated with a particularly high risk of complications harmful to the mother
Blood pressure control in hypertensive disorders of pregnancy
Cardiovascular Prevention and Pharmacotherapy
Hypertension is a major cause of maternal morbidity and occurs as a complication in up to one in ten pregnancies. Hypertensive disorders of pregnancy encompass gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. However, the management of hypertensive disorders of pregnancy remains a matter of debate, particularly the blood pressure thresholds and targets for managing hypertension in pregnancy. Previously, there was no clear evidence of the effectiveness of aggressive blood pressure control in pregnancy due to the risk of fetal growth restriction. Recent clinical trials have shown that aggressive control of blood pressure in pregnant women is safe for both the mother and fetus. The purpose of this paper is to present a clinically oriented guide to the drugs of choice in patients with hypertension during pregnancy, present contrasts among different guidelines and recent clinical trials, and discuss the blood pressure ...
Management of mild chronic hypertension during pregnancy: a review*1
Obstetrics & Gynecology, 2000
To conduct a systematic review of evidence relating to the management of mild chronic hypertension during pregnancy. This included the associated risks, benefits and harms of treatment with antihypertensive agents, non-pharmacologic measures and aspirin, and the benefits of various monitoring strategies. Searching The following electronic databases were searched for citations in any language: Biological Abstracts, CINAHL, the Cochrane Library, EMBASE, FEDRIP, HealthSTAR, HTA, MEDLINE, the Motherisk Program, REPROTOX and TERIS; and the databases of CCOHTA, Conseil d'Evaluation des Technologies de la Sante, the Health Services Utilization and Research Commission, the Institute for Clinical Evaluative Sciences, and the National Institute of Maternal and Child Health and Development (publications and clearing house). In addition, the references of articles and reviews were examined and a technical panel was consulted. All sources were searched from 1947, or their inception, until February 1999. Searches on harmful effects were supplemented with information from a primary text that routinely reviews and categorises teratogenic risks and two routinely updated textbooks that report serious adverse effects seen in nongravid populations (see Other Publications of Related Interest nos.1-3). Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) were eligible for assessing maternal and perinatal outcomes from antihypertensive treatment, and for assessing the benefits of aspirin. Case reports, case-control, cohorts, surveillance studies, RCTs and systematic reviews were eligible for assessing the harmful effect of antihypertensive treatment. Case series, cohort studies and RCTs were eligible for assessing foetal monitoring techniques and strategies. Specific interventions included in the review Pharmacologic antihypertensive agents, non-pharmacologic interventions, aspirin and foetal monitoring techniques.
Management of hypertension in pregnancy
Acta medica Indonesiana, 2015
Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC), cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in life-threatening situation for maternal and fetal health.
Updates in Management of Hypertensive Disorders of Pregnancy
Iris Publishers LLC, 2019
This work is licensed under Creative Commons Attribution 4.0 License WJGWH.MS.ID.000539. Introduction Interestingly, Hypertensive disorders of pregnancy (HDP) were discovered two thousand years ago but our knowledge and data about their nature and pathogenesis are still limited [1]. These disorders can affect many pregnant women all over the world putting them, their families and their countries under significant health burden. For instance, in USA, 240.000 pregnant suffer HDP which equal to 6-12% of all pregnancies [2] and this accounts for 10% of maternal morality being the second common cause of maternal death after postpartum hemorrhage [3]. Moreover, HDP may cause intrauterine fetal death, intrauterine growth restriction and prematurity [4]. Higher prevalence of HDP was found in African Americans, obese, patients with renal disease, chronic hypertensive patients, patients with autoimmune diseases, multiple pregnancy, diabetics and in pregnant women >35 years old or less than twenty [5,6]. Moreover, when we imagine the size of that problem in developing countries, we realize that it is a real disaster affecting families worldwide [7]. Many societies try to classify HDP in spite of presence of an overlap between these classes and subgroups under each category [1]. According to The American College of Obstetricians and Gynecologists (ACOG) and the National High Blood Pressure Education Program Working group on High blood pressure in pregnancy, HDP is classified into chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and preeclampsiaeclampsia superimposed on chronic hypertension [7]. There is difference in hemodynamic and neurohormonal profile of each category [8]. The main goal of all research efforts in treating HDP is how to prevent highly morbid complications and mortality of HDP that may affect both mother and fetus [9]. Mothers with HDP are at risk of renal and liver failure as part of multisystem nature
Hypertension (Dallas, Tex. : 1979), 2016
To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×10(9)/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6...
Management of hypertension in pregnancy: a descriptive report of two clinic practices
Hypertension in Pregnancy, 2019
Objective: To describe the current clinical practice in the treatment of hypertension in pregnancy. Methods: Retrospective chart review described hypertension treatment of pregnant women in two urban clinics in Minnesota USA, over 27 months. Data elements collected: blood pressure (BP) readings with gestational age, goal BP documented, and pharmacological treatments utilized. Results: Sixty patients had multiple elevated BP readings in prenatal care encounters. Of 60 included patients, 18 were treated with antihypertensives and 11 had documented BP goals. Documented goal BPs varied in numeric goal and some only listed systolic or diastolic goal. Conclusion: Inconsistencies exist in current treatment and documentation of hypertension in pregnancy.