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Review
. 2021 Feb;39(1):77-90.
doi: 10.1016/j.ccl.2020.09.005. Epub 2020 Nov 2.

Hypertensive Disorders of Pregnancy

Apurva M Khedagi  1 , Natalie A Bello  2
Affiliations
Review

Hypertensive Disorders of Pregnancy

Apurva M Khedagi et al. Cardiol Clin. 2021 Feb.

Abstract

Hypertension is the most common medical disorder occurring during pregnancy and a leading cause of maternal and perinatal morbidity and mortality. Accurate blood pressure measurement and the diagnosis and treatment of hypertensive disorders during pregnancy and in the postpartum period are pivotal to improve outcomes. This article details hemodynamic adaptations to pregnancy and provides an approach to the prevention, diagnosis, and management of hypertensive disorders of pregnancy (HDP) and hypertensive emergencies. In addition, it reviews optimal strategies for the care of women with hypertension during the fourth trimester and beyond to minimize future cardiovascular risk.

Keywords: Antihypertensive medications; Blood pressure; Hemodynamics; Hypertensive disorders of pregnancy; Maternal mortality; Preeclampsia.

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Conflict of interest statement

Disclosure N.A. Bello reports grant support from the National Institutes of Health, National Heart, Lung, and Blood Institute (K23 HL136853), and the Katz Foundation. A.M. Khedagi has nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Racial disparities in morbidity and mortality associated with hypertensive disorders. (Adapted from Singh GK, Siahpush M, Liu L, Allender M. Racial/Ethnic, Nativity, and Sociodemographic Disparities in Maternal Hypertension in the United States, 2014–2015. Int J Hypertens. 2018;2018:7897189 and Petersen EE DN, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019. 2019;68:423–429.)
Fig. 2.
Fig. 2.
Hemodynamic changes associated with pregnancy. a Blood pressure nadir reached at 18.6 weeks. BP, blood pressure; CO, cardiac output; HR, heart rate; SVR, systemic vascular resistance.
Fig. 3.
Fig. 3.
Identifying inaccuracies resulting from improper blood pressure measurement.
Fig. 4.
Fig. 4.
Classification of hypertensive disorders in pregnancy. HTN, hypertension.
Fig. 5.
Fig. 5.
Map of the United States showing the relationship between rate of uninsured women by state in 2019 and the Medicaid expansion status of the state as of March 2020. (Data from Status of State Medicaid Expansion Decisions: Interactive Map. Kaiser Family Foundation. Published 2020. Accessed 2020 and America’s Health Rankings analysis of U.S. Census Bureau. United Health Foundation. Published 2019. Accessed2020.)
See this image and copyright information in PMC

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