Management of Chronic and Gestational Hypertension of Pregnancy: A Guide for Primary Care Nurse Practitioners

Abstract

Aim: The aim of this discussion paper is to outline the guidelines, according to the American Congress of Obstetricians and Gynecologists, about how to manage hypertension before and during pregnancy. Primary providers lack the knowledge to initiate treatment and manage hypertension in patients who are family planning or in the early stages of pregnancy before transferring care to an obstetrician, or perhaps patients who never do transfer care for lack of accessibility or funding. This paper aims to discuss how the Family Nurse Practitioner, or other primary care providers, may safely and efficiently maintain stable blood pressures in patients with hypertension before, during, and after pregnancy.

Background and implications for nursing: Clinicians often defer gestational complications to obstetricians, however, it is crucial that there is a basic understanding of how to manage such issues. Primary practitioners do care for these patients during pre-gestation or fertility planning and oftentimes even during pregnancy in underserved communities with little access to obstetrical / prenatal care.

Design: Discussion paper of ACOG guidelines and recommendations regarding safe management of hypertension before, during and after pregnancy.

Data sources: Inclusion criteria utilized most current research within the past 5 years, barring one source from the American Heart Association (no more current data) from 2011. This included an examination of current standards of care regarding hypertension during and before pregnancy according to the ACOG. Utilizing keywords such as hypertension, gestational hypertension, pregnancy, pharmacological management of hypertension, ACOG guidelines, treatment of hypertension in pregnancy. The decision to utilize guidelines set forth primarily by ACOG stems from ACOG being the governing body for Obstetricians / Gynecologists. Additionally, "standardization of care improves patient outcomes, which also should translate into a reduction in medical-legal exposure" [2]. As "such guidelines have been developed by specialty organizations such as the American College of Obstetricians and Gynecologists (the college)," ACOG guidelines are nationally utilized in the care of OB/GYN patients.

Conclusion: It is essential for primary care clinicians to employ current research regarding hypertension surrounding pregnancy and encourage patients who are family planning to utilize all such data in order to have a healthy and successful pregnancy. In order to do so, thorough practitioners are required to care for patients throughout the spectrum of all health and wellness related situations.

Keywords: ACOG; Gastational hypertension; Hypertension; Obstetics; Pregestational hypertension; Women.