ABSTRACT
Hypertension is the most common medical complication of pregnancy. Since the prevalence of chronic (essential) hypertension increases with age through the childbearing years and many women in developed countries now bear children at increasing ages, as many as 5% of pregnancies in the United States occur in this high-risk group of women.1 In addition, approximately twice as many women (i.e. ~10%) develop hypertension during pregnancy.2 Importantly, the diagnosis of hypertension during pregnancy, assessment of maternal (and fetal) risks, targets for blood pressure (BP) control, and choice of pharmacologic agents all differ considerably compared to hypertension in nonpregnant women. This chapter will focus first on diagnosis and classification of hypertension in pregnancy, on the morbidities associated with hypertension in pregnancy, and on the goals of antihypertensive therapy in these patients. Throughout, we pay special attention to preeclampsia, since it is pathophysiologically and hemodynamically unique, occurs uniquely in pregnancy, and accounts for much of the
morbidity in these patients. While we touch on the physiology of maternal hemodynamic adaptation to normal and hypertensive pregnancy and current research into the mechanisms for and prevention of preeclampsia, our major focus is on diagnosis and therapy. We then review evaluation and medical management of chronic (mild to moderate) hypertension remote from delivery as well as antihypertensive and adjunctive management of more severe hypertension, often closer to term or in the setting of preeclampsia. Finally, we touch on antihypertensive selection in breastfeeding mothers.
