Pregnancy and hypertension

Abstract

Evaluation and treatment of hypertension in pregnancy is more the subject of consensus statements, meta-analyses, and often-thoughtful reviews than it is of well-designed and adequately-powered clinical studies or treatment trials. Care of these women depends on some understanding of the normal hemodynamic adaptations to pregnancy, on the differing pathophysiology of specific hypertensive disorders in pregnancy, and on pregnancy-specific concerns in blood pressure measurement. Choice of antihypertensive agents and blood pressure targets remain as important subjects for research, though guidelines are available. Importantly, blood pressure control in hypertensive gravidas should be but part of a multidisciplinary attempt to assure maternal well-being and optimize pregnancy outcome. This chapter attempts to provide the clinician with practical guidance regarding the evaluation and management of these high-risk pregnant women, with reference to the latest research and clinical information.