Treatment options for hypertension in pregnancy and puerperium

ABSTRACT

Introduction: Hypertensive disorders have become increasingly prevalent and complicate an increasing number of pregnancies. Therefore it is essential that the medications used to treat these disorders be well understood. Furthermore the management is complicated by special consideration needed for the physiologic changes of pregnancy as well as the consideration for possible adverse fetal effects.

Areas covered: We performed a review of the scientific literature of medications used to treat hypertensive disorders in pregnancy. We reviewed the guidelines used by different societies all over the world. We also discussed the pharmacodynamics, pharmacokinetics and possible adverse effects relating to the antihypertensive medications. Finally, we discussed the long-term maternal implications of these diseases.

Expert opinion: Overall, we encourage a step-wise approach to treating hypertensive disorders of pregnancy. While making sure to max out the use of one medications prior to shifting to another. Also, it is imperative not to be aggressive with treatment due to risk of compromising utero-placental blood flow. There is research currently involving biomarkers, nano-medicine and the placenta project with hopes of developing new targeted medications with a good fetal safety profile.

KEYWORDS:

• Antihypertensives
• chronic hypertension
• drugs
• gestational hypertension
• labetalol
• methyldopa
• nifedipine
• preeclampsia
• preeclampsia with severe features
• pregnancy
• teratogenesis

Article highlights

• In pregnancy, treatment goals are tailored to acute complications and fetal well-being.

• There are pregnancy related changes that effect the pharmacokinetic and pharmacodynamics properties of medications, however medication dosages that are used in pregnancy are inferred from studies done on non-pregnant patients.

• We recommend only starting treatment when systolic BP is 160 mm Hg or higher or diastolic BP of 105 mm Hg or higher. Due to fear of decreasing utero-placental blood flow.

• Our first choice agent is labetalol followed by calcium channel blockers.

• The dosing of labetalol in pregnancy is every 8 −12 hours. The dosing of calcium channel blocker extended release is once daily.

• Research in biomarkers, and nano-medicine to help deliver medications safely only to the mother and decrease placental transmission is underway.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded