💡 Managing chronic hypertension (HTN) in pregnancy is increasingly important due to rising maternal age, obesity, etc. Severe HTN (≥160/110 mm Hg) requires immediate treatment, but what about nonsevere cases (140/90+)? 🤔
📊 New data suggest treating nonsevere chronic HTN (140/90+) can improve outcomes, like reducing preeclampsia, without increasing risk of low-birth-weight babies. This supports using 140/90 as a threshold to step up therapy.
🩺 If managing HTN in pregnancy or for those planning pregnancy, consider:
- 1st-line meds: Nifedipine ER or labetalol — safe for fetal outcomes.
- ➡️ Avoid other CCBs — less safety data.
- Beta-blockers: Avoid atenolol, caution with others (except labetalol) due to fetal growth risks.
- Methyldopa: Trusted in pregnancy but currently discontinued.
- Thiazides: Second-line, 💊 but monitor for hypovolemia, especially early on.
- Spironolactone/eplerenone: Avoid, limited data in pregnancy.
- ACEI/ARB: 🚫 Always avoid in 2nd/3rd trimesters due to fetal injury risks.
👩⚕️ Make sure to guide BP med use carefully in pregnant patients or those planning to become pregnant!
References
- Tita AT, Szychowski JM, Boggess K, et al. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med. 2022;386(19):1781-1792.
- American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy. Obstet Gynecol. 2019;133(1):e26-e50.
- Whelton PK, Carey RM. The 2017 Clinical Practice Guideline for High Blood Pressure. JAMA. 2017;318(21):2073-2074.
