Management of Hypertension in Pregnancy

Diagnostic Classification and Treatment

The European Society of Cardiology recommends dihydropyridine calcium channel blockers, labetalol, and methyldopa as first-line medications for treating hypertension during pregnancy 1, 2
Hypertension in pregnancy is classified into several categories, including chronic hypertension, gestational hypertension, pre-eclampsia, and pre-existing hypertension with superimposed gestational hypertension with proteinuria 3, 4
The American College of Cardiology recommends drug treatment for pregnant women with confirmed office systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg 1, 2, 5
Target BP should be below 140/90 mmHg but not below 80 mmHg for diastolic BP 1, 2

Labetalol is an alpha/beta-blocker with efficacy comparable to methyldopa 3
Extended-release nifedipine is a dihydropyridine calcium channel blocker recommended as a first-line option 1, 2
Renin-angiotensin system (RAS) blockers are strictly contraindicated during pregnancy due to severe fetotoxicity 1, 2, 3

Severe hypertension (SBP ≥160 mmHg or DBP ≥110 mmHg) requires hospitalization and urgent treatment 4, 8
Intravenous options for hypertensive emergency include labetalol, hydralazine, and nifedipine 6, 7
Sodium nitroprusside should only be used when other treatments fail due to risk of fetal cyanide poisoning with prolonged administration 6, 8

Low to moderate-intensity exercise is recommended for all pregnant women without contraindications to reduce risk of gestational hypertension and pre-eclampsia 1, 2
Calcium supplementation (≥1 g daily) may be beneficial, particularly in high-risk women 3
Low-dose aspirin is recommended for women with history of early-onset (<28 weeks) pre-eclampsia 3, 8

Pre-pregnancy assessment is important for women with chronic hypertension to evaluate BP control and adjust medications if needed 6
Close monitoring is essential for all hypertensive pregnant women to detect early signs of pre-eclampsia 4