Chronic Hypertension in Pregnancy: Diagnosis and BP Measurement
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. List the definitions of chronic hypertension in pregnancy 2. Discuss the difficulty in making a diagnosis of superimposed preeclampsia
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Jan 9 2019 through 07/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
The ACOG guidance on chronic hypertension in pregnancy addresses diagnosis, particularly in light of the 2017 ACC/AHA recommendations that lowered the BP thresholds (see ‘Related ObG Topics’, below). ACOG states that for patients with stage 1 hypertension (systolic blood pressure of 130–139 mm Hg or diastolic blood pressure of 80–89 mm Hg)
…it is reasonable to continue to manage the patient in pregnancy as chronically hypertensive as specified in this guideline.
The uncertainty of the new approach to hypertension recommended by the ACA and AHA as applied to the care of pregnant women should be an active area of investigation.
Chronic Hypertension: Definitions and Criteria
Definition: Hypertension that is
Diagnosed or present before pregnancy or before 20 weeks of gestation
Diagnosed for the first time during pregnancy without resolution postpartum
Note: ACOG states that “the 20-week convention should not be used dogmatically, but rather for orientation while maintaining clinical judgment.”
Systolic BP: ≥140 mm Hg and/or
Diastolic BP: ≥90 mm Hg
≥2 determinations at least 4 hours apart
Note: In the context of severe hypertension, “the diagnosis can be confirmed within a shorter interval (even minutes) to facilitate timely therapy”
ACC/AHA criteria and definition
Lower threshold (see above) may result in false positive assignment of chronic hypertension
Preeclampsia that “complicates preexisting chronic hypertension”
May occur in up to 50% of women with chronic hypertension or higher with end-organ failure
Risk increased in the following
African American | Obesity | Smoker | Hypertension ≥4 years | DBP >100 mm Hg at baseline | Previous history of preeclampsia
Consider diagnosis in the following clinical scenarios
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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