This document discusses hypertension during pregnancy and classifies it into four categories: chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and preeclampsia superimposed on underlying hypertension. It defines each category and discusses their causes, symptoms, and management. Chronic hypertension is defined as hypertension before or after pregnancy. Gestational hypertension occurs after 20 weeks without proteinuria. Preeclampsia-eclampsia includes new hypertension and proteinuria after 20 weeks. It affects 5% of pregnancies and risks maternal and fetal health. The document recommends treating chronic hypertension if blood pressure is above 160/110 mmHg and below 140/90 mmHg if there is end-organ damage. First-line treatment includes

1. HYPERTENSION DURING
PREGNANCY
Dr. Sayeedur Rahman Khan Rumi
Dr.rumibd@gmail.com
MD Final Part Student
NHFH&RI

2. Classification of Hypertension
During Pregnancy
• Hypertension occurring during pregnancy
falls into one of four major classifications:
1. Chronic hypertension
2. Gestational hypertension (also called
transient hypertension)
3. Preeclampsia-eclampsia (also called
pregnancy-induced hypertension)
4. Preeclampsia superimposed on underlying
hypertension

3. Chronic hypertension
• The presence of hypertension before the
20th week of gestation or
• Persistent hypertension for longer than 12
weeks postpartum.
• Causes:
o Primary = “Essential Hypertension”
o Secondary = Result of other medical condition
(ie: renal disease)

4. Gestational hypertension
• Also called transient hypertension
• Elevated blood pressure first detected
after 20 weeks of gestation
• Without proteinuria

5. Preeclampsia-eclampsia
• Also called pregnancy-induced hypertension
• Defined by new onset of hypertension with a
systolic blood pressure ≥140 mm Hg or a
diastolic blood pressure ≥90 mm Hg after the
20th week of gestation in a previously
normotensive woman,
• Which is accompanied by <300 mg
proteinuria in 24 hours.

6. Preeclampsia-eclampsia (Cont’d)
• Preeclampsia occurs in approximately 5% of
pregnancies.
• It is associated with significant maternal and
fetal risk.
• In preeclamptic hypertension, the reasonable
goals for-
systolic blood pressure is 140 to 155 mm Hg and
diastolic is 90 to 105 mm Hg.

7. Chronic hypertension
• For management and counseling purposes, chronic
hypertension in pregnancy is also categorized as
either
– low risk or
– high risk
• The patient is considered to be at low risk when she
has mild essential hypertension without any organ
involvement.
• Women with low-risk chronic hypertension without
superimposed preeclampsia usually have a
pregnancy outcome similar to that in the general
obstetric population.

8. Chronic hypertension (Cont’d)
• Initiation of therapy is usually considered in
women without end-organ damage if systolic
blood pressure exceeds 160 mm Hg or
diastolic pressure exceeds 110 mm Hg.
• In women with end-organ damage, it is
desirable to keep the blood pressure below
140/90 mm Hg.

9. Algorithm for the management of pregnant women
with chronic hypertension.

10. Pharmacological
therapy

11. • ACEIs and ARBs are contraindicated and should be
discontinued as soon as pregnancy is detected.
• Women of child-bearing potential should be counseled about
the teratogenic potential of these agents.
• If drug therapy is necessary, methyldopa (250 mg twice daily
orally; maximum dose, 4 g/d) has a long track record of
safety and efficacy in pregnant patients and is often the
initial drug of choice.
• Hydralazine and β-blockers such as labetalol (100 mg twice
daily orally; maximum dose, 800 mg every 8 hours) can also
be used.
• Atenolol, a β-blocker without α-blocking properties, is
associated with lower placental and fetal weight at delivery
when used early in pregnancy.

12. ESC guideline on Cardiovascular Diseases during
Pregnancy

13. Antihypertensive drugs in pregnancy & doses

14. Thank you