Management of hypertension in pregnancy (2023)

SUMMARY

Hypertensive disorders of pregnancy are common and can result in maternal and fetal morbidity and mortality. Women may have chronic hypertension, or develop hypertension during pregnancy.

Management involves close maternal and fetal surveillance. If an antihypertensive drug is needed, prescribe one that is safe in pregnancy.

Pre-eclampsia is a hypertensive disorder of pregnancy. Women at high risk of pre-eclampsia should start aspirin 150 mg daily at 12–16 weeks gestation and continue until 36 weeks gestation, to reduce the risk of preterm delivery.

There are long-term cardiovascular and mortality risks associated with pregnancies complicated by gestational hypertension and pre-eclampsia. Ongoing cardiovascular and metabolic risk surveillance should be undertaken by the woman’s general practitioner.

Introduction

In a normal pregnancy, blood pressure falls in the first trimester. The fall reaches a maximum of 10–15 mmHg (systolic) in mid-pregnancy, and returns to pre-pregnancy levels by term. Hypertensive disorders of pregnancy affect approximately 5–10% of pregnancies in Australia. These disorders are associated with both maternal and fetal morbidity and mortality.

Hypertension

Hypertension is defined as a systolic blood pressure 140 mmHg or above, or diastolic blood pressure 90 mmHg or above. This should be confirmed over four hours with repeated measures, or after overnight rest, to determine if there is true hypertension.

Severe hypertension is classified as a systolic blood pressure 160 mmHg or above, or a diastolic blood pressure 110 mmHg or above. Severe hypertension (160/110 mmHg or above) requires urgent management in hospital.

Hypertensive disorders of pregnancy can be divided into four categories:

  • chronic hypertension
    • primary
    • secondary
  • gestational hypertension
  • pre-eclampsia and eclampsia
  • pre-eclampsia superimposed on chronic hypertension.

Chronic hypertension

Chronic hypertension predates the pregnancy or is first diagnosed before 20 weeks gestation. It includes both primary hypertension and less commonly secondary hypertension, related to an underlying cause, such as kidney disease. Routine testing for secondary causes is not recommended in pregnancy, but should be considered postpartum. For pregnant women with chronic hypertension, the initial recommended tests are: 1-3

  • full blood count
  • urea, creatinine and electrolytes
  • liver function tests
  • uric acid
  • urinalysis and microscopy
  • urine protein:creatinine ratio (to establish a baseline)
  • ECG.

Chronic hypertension is associated with adverse maternal and fetal outcomes:

  • superimposed pre-eclampsia – 25%
  • preterm delivery – 28%
  • fetal growth restriction – 17%
  • perinatal death – 4%.4

Some women have white-coat hypertension. This is defined as a clinic blood pressure of at least 140/90 mmHg, but with normal blood pressure outside the clinic. It is diagnosed by 24-hourambulatory blood pressure monitoring or home blood pressure monitoring. White-coat hypertension is not entirely benign and is associated with an increased risk of pre-eclampsia (8%).5 Generally, treatment is not required if the clinic blood pressure is below 160/110 mmHg and the out-of-office blood pressure remains normal.

Management

Women with chronic hypertension may be taking antihypertensive drugs before conception or conceive while taking them. Some of these drugs are contraindicated or not recommended in pregnancy (Table 1).6 Table 2 lists oral antihypertensive drugs that are safer in pregnancy.2,6

(Video) Management of Chronic Hypertension in Pregnancy

Table 1 - Antihypertensive drugs to avoid in pregnancy

Antihypertensive class

Advice

Potential adverse effects

Recommendation

ACE inhibitors

Contraindicated

Teratogenic in the second and third trimester resulting in fetal anuria, oligohydramnios, hypocalvaria, intrauterine growth restriction and patent ductus arteriosus, death

Stop drug ideally before conception or at diagnosis of pregnancy

Angiotensin receptor blockers

Contraindicated

Teratogenic in the second and third trimesters, fetal anuria, oligohydramnios, hypocalvaria, intrauterine growth restriction, patent ductus arteriosus, death

Stop drug ideally before conception or at diagnosis of pregnancy

Diuretics

Avoid

Maternal hypovolaemia, fetal hypoglycaemia, thrombocytopenia, hyponatraemia and hypokalaemia

Use an alternative antihypertensive

Beta blockers (other than labetalol)

Avoid

Fetal bradycardia, intrauterine growth restriction (atenolol)

Use an alternative antihypertensive

Calcium channel antagonists (other than nifedipine and diltiazem)

Avoid

Maternal hypotension and fetal hypoxia

Use an alternative antihypertensive

Table 2 - Antihypertensive drugs that can be safely used in pregnancy

Antihypertensive drug*

Class/action

Dose

Adverse effects

Labetalol

Beta blocker

100 mg twice a day – 400 mg three times a day

Bradycardia, bronchospasm, headache

Nifedipine controlled release

Calcium channel antagonist

30 mg daily – 60 mg twice a day

Headache (first-dose effect), flushing, tachycardia, peripheral oedema

Methyldopa

Central action

250 mg twice a day – 750 mg three times a day

Depression, dry mouth, sedation, rarely haemolysis and hepatitis

Hydralazine

Vasodilator

25 mg three times a day – 50 mg three times a day

Flushing, headache, lupus-like syndrome

Prazosin

Alpha blocker

0.5 mg twice a day – 5 mg three times a day

Orthostatic hypotension

*Although oxprenolol is safe, it is no longer available in Australia.

The mainstay of management of chronic hypertension in pregnancy is regular maternal review and strict blood pressure control. Often the physiological fall in blood pressure in the first trimester will allow for a reduction or cessation of antihypertensive drug therapy.

Optimal management includes maintaining the blood pressure around 110–140/85 mmHg, regular assessment for the development of pre-eclampsia and close surveillance of fetal growth and wellbeing. Signs and symptoms suggestive of pre-eclampsia include headache, visual changes, epigastric or right upper quadrant pain and oedema (see Box). Assessment also includes careful blood pressure measurement, ideally using automated office or a liquid crystal sphygmomanometer, and testing for proteinuria. Home blood pressure monitoring may form part of this assessment. Proteinuria is defined as a spot urine protein:creatinine ratio above 30 mg/mmol or urine protein excretion above 300 mg/24 hours. Dipstick urinalysis (automated or visual) is most commonly used to screen for proteinuria, with a ‘negative’ or ‘trace’ result being normal. One plus (1+) or more on dipstick is sensitive, but inaccurate and should be further evaluated with a spot urine protein:creatinine ratio.

Gestational hypertension

Gestational hypertension is the development of hypertension at or after 20 weeks gestation, in the absence of other features of pre-eclampsia (see Box). Gestational hypertension is associated with an increased risk of developing pre-eclampsia (up to 25%, depending on the gestation at presentation), as well as the future development of cardiovascular disease.1-3 Fetal growth restriction is not typically a feature of gestational hypertension.

Box - Features of pre-eclampsia and eclampsia

Renal

  • proteinuria – spot urine protein:creatinine ratio 30 mg/mmol or more
  • acute kidney injury with serum creatinine >90 micromol/L
  • oliguria: <80 mL/4 hours

Haematological

  • thrombocytopenia – platelet count <100,000/microlitre
  • haemolysis
  • disseminated intravascular coagulation

Hepatic

  • raised serum transaminases (alanine aminotransferase or aspartate aminotransferase >40 IU/L)
  • severe right upper quadrant or epigastric pain

Neurological

  • eclamptic convulsion
  • sustained clonus (hyperreflexia is commonly found and not diagnostic)
  • severe headache
  • visual disturbance – photopsia, scotomata, cortical blindness
  • stroke

Pulmonary oedema

Uteroplacental dysfunction with fetal growth restriction, abnormality on doppler imaging of the umbilical artery, stillbirth

(Video) Treating Mild Chronic Hypertension during Pregnancy | NEJM

Management

Regular blood pressure monitoring is necessary to ensure the blood pressure remains at 110–140/80–90 mmHg. There should be regular assessment for the development of pre-eclampsia and close surveillance of fetal growth and wellbeing. Once the blood pressure is controlled, gestational hypertension may continue to be managed with outpatient care, under close and regular review.

Pre-eclampsia

Pre-eclampsia is a complex multisystem disorder of pregnancy arising from abnormal placentation, resulting in an imbalance of angiogenic and anti-angiogenic factors, oxidative stress and immunological involvement. The maternal response to this is thought to involve systemic vascular endothelialdysfunction. Pre-eclampsia may be superimposed on chronic hypertension, or present as new onset hypertension, arising at or after 20 weeks gestation, with the presence of one or more of the typical clinical features (see Box).1,2

Risk factors for pre-eclampsia include maternal age, primiparity, previous pre-eclampsia, multiple gestation, prolonged interpregnancy interval and assisted reproduction therapies. Other factors are underlying renal disease or hypertension, antiphospholipid syndrome, systemic lupus erythematosus, diabetes and a maternal body mass index (BMI) above 30 kg/m2.

Adverse maternal outcomes include eclampsia, stroke, multiorgan failure, major haemorrhage and death. Fetal complications of pre-eclampsia include growth restriction, preterm delivery, placental abruption and perinatal death.

Management

Whether pre-eclampsia is new onset or superimposed on chronic hypertension, a multidisciplinary approach optimises maternal and fetal outcomes as delivery is the only definitive cure. There is a balance between the welfare of the growing fetus and the ongoing risk of maternal complications. Management should occur at a specialist centre with the required protocols and expertise because inpatient care is usually required.

For severe hypertension urgent management is indicated and drugs are required to rapidly lower blood pressure (Table 3). An infusion of magnesium sulphate can be considered as it reduces the rate of seizure by 50% (Table 4).7

(Video) Causes of Hypertension (High Blood Pressure) in Pregnancy | Mass General Brigham

Table 3 - Urgent treatment of severe hypertension* in pregnancy

Drug

Dose

Route

Onset of action

Adverse effects

Hydralazine

5–10 mg

Intravenous bolus repeated after 20 min if blood pressure remains

>160/110 mmHg

20 min

Flushing, headache, nausea, hypotension, tachycardia

Labetalol

20–80 mg

Intravenous bolus over 2 min, repeat after 10 min if blood pressure remains >160/110mmHg

5 min

Bradycardia, hypotension, fetal bradycardia

Labetalol

200 mg

Oral

30–45 min

Bradycardia, bronchospasm, headache

Nifedipine†

10 mg

Oral

30–45 min

Headache, flushing

*Severe hypertension is 160/110 mmHg or above.

† This formulation is no longer available in Australia.

Table 4 - Seizure prophylaxis and treatment of eclampsia

Drug

Dose

Route

Onset of Action

Adverse effects

Magnesium

4 g

Intravenous bolus over20 min followed by 1 g/hourinfusion, typically continuedfor 24 hours

20 min

Flushing, respiratory depression

Caution in renal impairment asmagnesium is excreted renallyand toxicity may occur

Prediction and prevention

A number of options are available in the first trimester for predicting the risk of pre-eclampsia. These include using maternal blood pressure and risk factors or combined prediction models using additional tests of placental growth factor and doppler imaging of the uterine artery. These tests are readily available and consideration needs to be given to how they could be integrated into antenatal care. In Australia, however, the cost effectiveness of combined first trimester screening for pre-eclampsia has yet to be evaluated.

Although there is no current method of preventing pre-eclampsia, aspirin is recommended for women considered to be at high risk because of maternal risk factors or by clinical prediction models. The ASPRE trial used combined first trimester screening and found a 62% reduction in preterm pre-eclampsia at less than 37 weeks gestation in women who took aspirin 150 mg daily.8 Women at high risk require early obstetric review, because starting aspirin before 16 weeks is most effective. If started for pre-eclampsia prophylaxis, aspirin should be continued until36 weeks gestation. Aspirin reduces the risk of preterm birth, fetal growth restriction and fetal death, but may increase postpartum bleeding.9,10

Women with an inadequate dietary calcium intake may have an increased risk of pre-eclampsia. They should aim to achieve the recommended daily allowance (1000 mg daily) through diet or calcium supplementation to reduce the risk.11

Postpartum management

After delivery, hypertension typically resolves within 12 weeks for women with gestational hypertension or pre-eclampsia. If this does not occur, consideration should be given to investigation for primary or secondary hypertension. Regular monitoring of blood pressure postnatally should occur, with down titration of antihypertensive drugs when the systolic blood pressure drops below 120 mmHg. For women with chronic hypertension, the decision to return to their usual antihypertensive treatment will depend on its compatibility with breastfeeding, and their future pregnancy plans. It would be reasonable to transition them back to their usual treatment early, provided they remain aware of the importance of review before future pregnancies to ensure it will be safe to use.

The antihypertensive drugs that are safe in pregnancy are also safe in breastfeeding. However, given that methyldopa is associated with a 30% risk ofdepression, it is usually stopped postpartum. ACE inhibitors, particularly enalapril, have very low concentrations in breast milk and are often used during lactation. Angiotensin receptor blockers are not recommended due to a lack of available safety information.

(Video) Hypertension in Pregnancy Mnemonic

Long-term implications

Gestational hypertension and pre-eclampsia are associated with a two- to fourfold increase in the future risk of cardiovascular disease. Women may develop hypertension, stroke, diabetes, venous thromboembolic disease or chronic kidney disease. Cardiovascular events such as stroke may occur in middle age. Given these risks, and the cumulative risks associated with several pregnancies complicated by severe pre-eclampsia, or preterm delivery, preconception counselling before future pregnancies is recommended.

Women with a history of hypertension in pregnancy require indefinite follow-up. They are recommended to have annual reviews of blood pressure, fasting lipids and blood glucose. Counselling on a healthy lifestyle and diet, maintenance of an optimal BMI, smoking cessation and regular exercise are essential for optimising long-term health outcomes.12-14

Conflicts of interest: none declared

This article is peer-reviewed.

Australian Prescriber welcomes Feedback.

References

  1. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al.; International Society for the Study of Hypertension in Pregnancy (ISSHP). The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018;13:291-310.
  2. Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, et al. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015;55:e1-29.
  3. Gestational hypertension and preeclampsia. ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol 2020;135:1492-5.
  4. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 2014;348:g2301.
  5. Brown MA, Mangos G, Davis G, Homer C. The natural history of white coat hypertension during pregnancy. BJOG 2005;112:601-6.
  6. Briggs GG, Freeman RK. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 10th edition. Philadelphia (PA): Lippincott Williams & Wilkins; 2014.

  7. The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002;359:1877-90.
  8. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017;377:613-22.
  9. Duley L, Meher S, Hunter KE, Seidler AL, Askie LM. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2019;2019:1465-858.
  10. Hastie R, Tong S, Wikström AK, Sandström A, Hesselman S, Bergman L. Aspirin use during pregnancy and the risk of bleeding complications: a Swedish population-based cohort study. Am J Obstet Gynecol 2021;224:95.e1-12.
  11. Hofmeyr GJ, Lawrie TA, Atallah AN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2018;10:CD001059.
  12. Theilen LH, Fraser A, Hollingshaus MS, Schliep KC, Varner MW, Smith KR, et al. All-cause and cause-specific mortality after hypertensive disease of pregnancy. Obstet Gynecol 2016;128:238-44.
  13. Tooher J, Thornton C, Makris A, Ogle R, Kord A, Horvath J, et al. Hypertension in pregnancy and long-term cardiovascular mortality: a retrospective cohort study. Am J Obstet Gynecol 2016;214:722 e1–e6.
  14. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007;335:974.

FAQs

How is hypertension managed during pregnancy? ›

The mainstay of management of chronic hypertension in pregnancy is regular maternal review and strict blood pressure control. Often the physiological fall in blood pressure in the first trimester will allow for a reduction or cessation of antihypertensive drug therapy.

What is first-line treatment for hypertension in pregnancy? ›

Background: Hydralazine, labetalol, and nifedipine are the recommended first-line treatments for severe hypertension in pregnancy.

What is the drug of choice for hypertension in pregnancy? ›

Methyldopa is a drug of first choice for control of mild to moderate hypertension in pregnancy and is the most widely prescribed antihypertensive for this indication in several countries, including the US and the UK.

WHO guideline for hypertension in pregnancy? ›

Aim to keep the woman's BP <150/100 mm Hg. Women who develop severe hypertension >160 mmHg (systolic) and/or 110 mmHg(diastolic) (average of 3 readings over 30 minutes) should be managed according to the SEVERE PRE- ECLAMPSIA GUIDELINE.

What are the 4 types of hypertension in pregnancy? ›

What are the types of high blood pressure during pregnancy?
  • Chronic hypertension. In chronic hypertension, high blood pressure develops either before pregnancy or during the first 20 weeks of pregnancy. ...
  • Chronic hypertension with superimposed preeclampsia. ...
  • Gestational hypertension. ...
  • Preeclampsia.

Which antihypertensive drug is contraindicated in pregnancy? ›

The choice of antihypertensive drugs also is discussed; methyldopa, labetalol, and nifedipine, among others, appear safe for use in pregnancy, whereas angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be avoided.

Why ACE inhibitors are contraindicated in pregnancy? ›

It is well accepted that angiotensin-converting enzyme (ACE) inhibitors are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage.

Why is labetalol first choice in pregnancy? ›

Labetalol can help to control high blood pressure and therefore reduces the risk of pregnancy complications.

Which diuretic is safe in pregnancy? ›

Loop diuretics, especially furosemide (C), have been used in pregnancy to treat pulmonary edema, severe hypertension in the presence of chronic kidney disease, or congestive heart failure despite the potential risk of neonatal hyperbilirubinemia (Turmen et al. 1982).

Is amlodipine safe during pregnancy? ›

Amlodipine can be used in pregnancy. Although there is not a lot of information on its safety, it is not thought to be harmful to the baby. If you are pregnant, or planning a pregnancy, talk to your doctor about it. They may wish to change amlodipine for a medicine that has more safety information.

Which is the best medicine for high blood pressure? ›

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels.
  • Common examples are enalapril, lisinopril, perindopril and ramipril.
  • The most common side effect is a persistent dry cough. ...
  • Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan.

What is a BP profile in pregnancy? ›

Background: A blood pressure profile (BPP) is often used to diagnose and manage hypertension in pregnancy. However, there is no consensus on the number and interval of blood pressure (BP) readings required.

When should I start using antihypertensive in pregnancy? ›

Our practice is to initiate treatment when BP is ≥150 systolic and 90 to 100 mm Hg diastolic. When the diagnosis is preeclampsia, the gestational age, as well as the level of BP, influences the use of antihypertensive therapy.

When is IV labetalol given during pregnancy? ›

In the hypertension of pregnancy: The infusion can be started at the rate of 20mg per hour and this dose may be doubled every thirty minutes until a satisfactory reduction in blood pressure has been obtained or a dosage of 160mg per hour is reached. Occasionally, higher doses may be necessary.

What causes high BP in pregnancy? ›

Unhealthy lifestyle choices may lead to high blood pressure during pregnancy. Being overweight or obese, or not staying active are major risk factors for high blood pressure.

What BP number is preeclampsia? ›

When you have preeclampsia, your blood pressure is elevated (higher than 140/90 mmHg), and you may have high levels of protein in your urine. Preeclampsia puts stress on your heart and other organs and can cause serious complications.

Which medication is contraindicated during pregnancy? ›

Some of the over-the-counter medicines that increase the chances of birth defects are: Bismuth subsalicylate (such as Pepto-Bismol). Phenylephrine or pseudoephedrine, which are decongestants. Avoid medicines with these ingredients during the first trimester.

Is labetalol safe during pregnancy? ›

You can take labetalol while you are pregnant. Labetalol can affect the baby's growth in the womb so you may be offered extra scans to check that your baby is growing OK. There's also a small chance that labetalol can affect a baby's blood sugar levels just after birth.

Are diuretics safe in pregnancy? ›

Diuretics are not routinely recommended in pregnancy due to the potential risk of altered uteroplacental blood flow, and in the case of spironolactone and eplerenone, antiandrogenic effects which could theoretically affect the development of a male fetus.

Is nifedipine safe in pregnancy? ›

Conclusions: The dihydropyridine group of calcium channel blockers (type II calcium blockers) and, specifically, nifedipine are safe for use in pregnancy. They have little teratogenic or fetotoxic potential.

Is losartan safe in pregnancy? ›

Losartan is not recommended in pregnancy. It can reduce the level of fluid around your baby, particularly if you take it in the second and third trimesters of pregnancy. This can result in long-term damage to your baby's kidneys and lungs and a number of other problems.

Can Lasix be given in pregnancy? ›

Furosemide is safe to take in pregnancy, although it will only be prescribed if you have specific medical conditions. If you're trying to get pregnant or are already pregnant, talk to your doctor about whether taking furosemide is right for you.

How many mg of labetalol is safe during pregnancy? ›

Hypertension in Pregnancy: An initial dosage of 100 mg twice daily may be increased, if necessary at weekly intervals by 100 mg twice daily.

Why is nifedipine contraindicated in pregnancy? ›

Histologic changes in uterine musculature and cervical collagen were consistent with the inhibitory effects of nifedipine on uterine contractions. Conclusion: The results suggest that, in addition to tocolysis, nifedipine can cause vascular dilatation in both the uterus and the placenta.

Which is better methyldopa or labetalol? ›

Conclusions: Labetalol is better tolerated than methyldopa, gives more efficient control of blood pressure and may have a ripening effect on the uterine cervix.

Are beta blockers safe in pregnancy? ›

Studies have not shown that beta blockers cause birth defects, stillbirth or preterm birth. Women taking beta blockers may be more likely to have a small baby; however a small baby can be due to underlying health conditions that beta blockers are commonly used to treat, like high blood pressure.

Why is furosemide not given during pregnancy? ›

Using this medicine while you are pregnant may cause your unborn baby to be bigger than normal. If you think you have become pregnant while using this medicine, tell your doctor right away. This medicine may cause you or your child to lose more potassium from your body than normal (hypokalemia).

Is metformin safe during pregnancy? ›

In recent years, metformin has gained acceptance as a safe, effective and rational option for reducing insulin resistance in pregnant women with type 2 diabetes, gestational diabetes (GDM) or polycystic ovarian syndrome (PCOS). It may also provide benefit in obese non-diabetic women during pregnancy.

Is metoprolol safe in pregnancy? ›

Are there any risks of taking metoprolol in pregnancy? A small number of pregnant women specifically taking metoprolol have been studied, with no concerns raised that its use causes birth defects or preterm birth. Metoprolol belongs to a family of medicines called beta blockers.

Is methyldopa safe in pregnancy? ›

Use of methyldopa in pregnancy is common and is unlikely to cause any harm. Most pregnant women taking methyldopa will start treatment after the first trimester when the baby is fully developed. This will therefore not cause structural birth defects in the baby.

Is calcium channel blockers safe in pregnancy? ›

Three studies found no association between gestational exposure to calcium channel blockers and congenital heart defects, although overall numbers studied are small and confounded, therefore these findings remain to be confirmed.

What is the first line drug of choice for hypertension? ›

There are three main classes of medication that are usually in the first line of treatment for hypertension: 1. Calcium Channel Blockers (CCB) 2. Angiotensin Converting Enzyme inhibitors (ACE inhibitors or ACE-I) and Angiotensin Receptor Blockers (ARBs) 3. Diuretics.

What is the first aid for high blood pressure at home? ›

Sit down and focus on your breathing. Take a few deep breaths and hold them for a few seconds before releasing. Take your blood pressure medication if your doctor has prescribed something for you. A cup of hibiscus or chamomile tea can also help you feel calmer, it is a good idea to stock up on these teabags.

How do you lower your blood pressure immediately? ›

How can I lower my blood pressure immediately? There is no way to lower blood pressure quickly at home. A person should follow a plan of diet, exercise, and possibly medication to lower their blood pressure over time. If blood pressure is over 180/120 , the person should call 911.

What is the management of preeclampsia? ›

Treatment of severe preeclampsia

Medications to treat severe preeclampsia usually include: Antihypertensive drugs to lower blood pressure. Anticonvulsant medication, such as magnesium sulfate, to prevent seizures. Corticosteroids to promote development of your baby's lungs before delivery.

What is the management of eclampsia? ›

Magnesium sulfate should be given to control convulsions and is the first-line treatment for eclamptic seizures. A loading dose of 4 to 6 grams should be given intravenously over 15 to 20 minutes. A maintenance dose of 2 g per hour should subsequently be administered.

Can drinking water lower blood pressure during pregnancy? ›

This extra demand on her kidneys produces a greater need for water. Drinking water is necessary for normal cholesterol levels and blood pressure. A mother's blood pressure usually returns to normal after the baby is born and the placenta is delivered.

What are the diet modifications and considerations for a pregnant mother with hypertension? ›

Eat and drink at least 4 servings of calcium rich foods like dairy products like milk, paneer, curd, soya milk, whole pulses, whole cereals, green leafy vegetables. Eat at least one source of vitamin A every day like carrots, egg, pumpkins, spinach, green leafy vegetables. Iron rich foods should be taken.

What BP number is preeclampsia? ›

When you have preeclampsia, your blood pressure is elevated (higher than 140/90 mmHg), and you may have high levels of protein in your urine. Preeclampsia puts stress on your heart and other organs and can cause serious complications.

What is the first choice for preeclampsia? ›

For emergency treatment in preeclampsia, IV hydralazine, labetalol and oral nifedipine can be used [1]. The ACOG Practice Bulletins also recommend that methyldopa and labetalol are appropriate first-line agents and beta-blockers and angiotensin-converting enzyme inhibitors are not recommended [21, 17].

What is normal blood pressure during pregnancy? ›

The American College of Obstetricians and Gynecologists (ACOG) state that a pregnant woman's blood pressure should also be within the healthy range of less than 120/80 mm Hg. If blood pressure readings are higher, a pregnant woman may have elevated or high blood pressure.

What is the difference between preeclampsia and eclampsia? ›

Preeclampsia and eclampsia are pregnancy-related high blood pressure disorders. Preeclampsia is a sudden spike in blood pressure. Eclampsia is more severe and can include seizures or coma.

Why does aspirin prevent preeclampsia? ›

Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane and inhibiting inflammation and platelet aggregation. Such an effect has led to the hypothesis that aspirin could be useful for preventing preeclampsia.

How is MgSO4 given in eclampsia? ›

Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre-eclampsia. It is usually given by either the intramuscular or intravenous routes.

What causes high BP in pregnancy? ›

Pre-eclampsia is a condition that affects some pregnant women, typically after 20 weeks. It is a problem with the placenta that usually causes your blood pressure to rise. If left untreated, pre-eclampsia can be dangerous for you and your baby.

How can you bring your blood pressure down quickly? ›

How Can I Lower My Blood Pressure Immediately?
  1. Take a warm bath or shower. Stay in your shower or bath for at least 15 minutes and enjoy the warm water. ...
  2. Do a breathing exercise. Take a deep breath from your core, hold your breath for about two seconds, then slowly exhale. ...
  3. Relax!

Does bed rest help high blood pressure pregnancy? ›

Women with high blood pressure are often advised to rest in bed either at home or in hospital. It is suggested that this might help to reduce the mother's blood pressure and so provide benefits for the baby.

What is the diagnostic criteria for hypertension with pregnancy? ›

Criteria for hypertension — During pregnancy, hypertension is defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Severe hypertension is defined as systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg.

What are the complications of hypertension in pregnancy? ›

Complications from high blood pressure for the mother and infant can include the following: For the mother: preeclampsia , eclampsia , stroke, the need for labor induction (giving medicine to start labor to give birth), and placental abruption (the placenta separating from the wall of the uterus).

What is severe hypertension in pregnancy? ›

Severe hypertension in pregnancy is defined as a sustained systolic blood pressure of 160 mmHg or over or diastolic blood pressure of 110 mmHg or over. The most common cause of severe hypertension in pregnancy is pre-eclampsia, which presents after 20 weeks' gestation.

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