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Hypertension in pregnancy - Management
How should I manage a woman with chronic hypertension?

  • Advise the woman that:
    • She should restrict her dietary intake of salt (sodium). For more information, see the section on Lifestyle advice in the CKS topic on Hypertension - not diabetic.
    • Bed rest is not recommended.
    • She will require regular monitoring of her blood pressure throughout her pregnancy, and is likely to require more frequent antenatal checkups than usual.
    • The aim of treatment is to adequately control her blood pressure throughout her pregnancy.
      • For uncomplicated hypertension, keep the blood pressure less than 150/100 mmHg (but diastolic pressure no less than 80 mmHg).
      • If there is evidence of target-organ damage (for example kidney disease), keep the blood pressure less than 140/90 mmHg.
  • Warn about symptoms of pre-eclampsia and that she should seek immediate advice if she develops any symptoms after 20 weeks' gestation (including during the postpartum period).
  • Prescribe aspirin 75 mg daily from 12 weeks' gestation. Explain that this is believed to help prevent the development of pre-eclampsia.
    • Seek specialist advice before prescribing aspirin if blood pressure is uncontrolled.
  • If she is taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-II receptor antagonist (AIIRA), stop this immediately and prescribe an alternative treatment if necessary.
    • Explain that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy.
  • Refer the woman to a specialist in hypertensive disorders if the woman has secondary hypertension, or a renal physician, an endocrinologist, or a specialist in connective tissue disease as appropriate.
  • Otherwise, refer the woman to an obstetric physician.
    • While the woman is waiting to see a specialist, continue her usual antihypertensive treatment (unless she is taking an ACE inhibitor or AIIRA).
    • If the woman is not currently taking antihypertensive treatment:
      • If her blood pressure is high, discuss management with a specialist.
      • If her blood pressure is normal (which may be because of the physiological drop in blood pressure that occurs in early pregnancy), monitor her blood pressure regularly.
  • If the woman develops proteinuria after 20 weeks' gestation then her care becomes that of a woman with pre-eclampsia.

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