ACOG has released recommendations on chronic hypertension in pregnancy. Management of chronic hypertension in pregnancy depends on gestational age and symptoms. Initial assessment, including identification of end-organ damage and evaluation of medications will drive treatment and delivery planning.
Laboratory tests
The benefits of treating mild to moderate chronic hypertension in pregnancy are not clear, thus a conversation with patients (i.e. shared decision-making) is warranted. Timing of delivery depends on severity of disease and gestational age. Women with chronic hypertension remain at risk for complications during the postpartum period so early follow-up is recommended.
Choice of Antihypertensive
Threshold for Initiation of therapy
Patient on medications prior to pregnancy
Target BP
Aspirin
…expectant management beyond 39 0/7 weeks of gestation should only be done after careful consideration of the risks and benefits and with appropriate surveillance
ACOG Practice Bulletin 203: Chronic Hypertension in Pregnancy
SMFM Statement: Antihypertensive therapy for mild chronic hypertension in pregnancy (The CHAP Trial)
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.
ACOG Practice Bulletin 203: Chronic Hypertension in Pregnancy
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