Evaluation and Management of Hypertensive Disorders of Pregnancy

Abstract

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies and remain the major cause of maternal and neonatal morbidity and mortality. Hypertensive disorders of pregnancy can be classified into four groups depending on the onset of hypertension and the presence of target organ involvement: chronic hypertension, preeclampsia, gestational hypertension, and superimposed preeclampsia on chronic hypertension. Hypertension during pregnancy is associated with a higher risk of cardiovascular disease and kidney failure. Early diagnosis and proper treatment for pregnant women with hypertension remain a priority since this leads to improved maternal and fetal outcomes. Labetalol, nifedipine, methyldopa, and hydralazine are the preferred medications to treat hypertension during pregnancy. In this comprehensive review, we discuss the diagnostic criteria, evaluation, and management of pregnant women with hypertension.

Figure 1

Spectrum of hypertensive disorders in pregnancy. HELLP, hemolysis, elevated liver enzymes, low platelets.

Figure 2

Pathophysiology of preeclampsia. PlGF, placental growth factor; sENG, soluble endoglin; sFlt-1, soluble FMS-like tyrosine kinase 1; VEGF, vascular endothelial growth factor; ARDS, acute respiratory distress syndrome; DIC, disseminated intravascular coagulation; CNS, central nervous system.

Figure 3

Long-term outcomes of preeclapmsia.^– OR, odds ratio; aHR, adjusted hazard ratio; aRR, adjusted risk ratio; HR, hazard ratio.

Figure 4

Treatment of hypertensive disorders of pregnancy. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker.