Am J Perinatol 2019; 36(02): 161-168
DOI: 10.1055/s-0038-1666976
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Chronic Hypertension in Pregnancy: New Concepts for Classification and Management

Khalil M. Chahine
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
,
Baha M. Sibai
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
› Author Affiliations
Further Information

Publication History

21 February 2018

03 June 2018

Publication Date:
09 July 2018 (online)

Abstract

Chronic hypertension in pregnancy is traditionally classified according to degree of blood pressure (BP) elevation. Alternatively, stratifying women as high or low risk based on the etiology of hypertension, baseline work-up, and comorbid medical conditions will better inform clinicians about thresholds to initiate antihypertensive therapy, target BPs, frequency of antepartum visits, and timing of delivery. Women classified as high-risk chronic hypertension as described here require stricter BP management and more frequent follow-up visits as their associated rates of adverse maternal and/or fetal/neonatal outcomes appear higher than women classified as low-risk chronic hypertension. The latter group can in most cases be managed similarly to the general obstetric population.

 
  • References

  • 1 Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
  • 2 Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012; 206 (02) 134.e1-134.e8
  • 3 Whelton PK, Carey RM, Aronow WS. , et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71 (06) e13-e115
  • 4 Ankumah NE, Sibai BM. Chronic hypertension in pregnancy: diagnosis, management, and outcomes. Clin Obstet Gynecol 2017; 60 (01) 206-214
  • 5 Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100 (02) 369-377
  • 6 Chobanian AV, Bakris GL, Black HR. , et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289 (19) 2560-2572
  • 7 James PA, Oparil S, Carter BL. , et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (05) 507-520
  • 8 Pickering TG, Hall JE, Appel LJ. , et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 111 (05) 697-716
  • 9 Taler SJ. Secondary causes of hypertension. Prim Care 2008; 35 (03) 489-500
  • 10 Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. Int J Hypertens 2011; 2011: 236239
  • 11 Dietz PM, England LJ, Shapiro-Mendoza CK, Tong VT, Farr SL, Callaghan WM. Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med 2010; 39 (01) 45-52
  • 12 Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol 1996; 144 (09) 881-889
  • 13 Henderson JT, Whitlock EP, O'Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160 (10) 695-703
  • 14 Leon MG, Moussa HN, Longo M. , et al. Rate of gestational diabetes mellitus and pregnancy outcomes in patients with chronic hypertension. Am J Perinatol 2016; 33 (08) 745-750
  • 15 Bateman BT, Huybrechts KF, Fischer MA. , et al. Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study. Am J Obstet Gynecol 2015; 212 (03) 337.e1-337.e14
  • 16 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1): 323-333
  • 17 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (04) 908-910
  • 18 Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2014; 2 (02) CD002252
  • 19 Sibai BM, Abdella TN, Anderson GD. Pregnancy outcome in 211 patients with mild chronic hypertension. Obstet Gynecol 1983; 61 (05) 571-576
  • 20 Magee LA, von Dadelszen P, Rey E. , et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med 2015; 372 (05) 407-417
  • 21 SMFM Publications Committee. SMFM Statement: benefit of antihypertensive therapy for mild-to-moderate chronic hypertension during pregnancy remains uncertain. Am J Obstet Gynecol 2015; 213 (01) 3-4
  • 22 Sibai BM, Lindheimer M, Hauth J. , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. N Engl J Med 1998; 339 (10) 667-671
  • 23 Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ 2008; 336 (7637): 211-215
  • 24 Yanit KE, Snowden JM, Cheng YW, Caughey AB. The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. Am J Obstet Gynecol 2012; 207 (04) 333.e1-333.e6