Abstract
1 Elucidation of some of the mechanisms responsible for blood pressure elevation in pregnancy has permitted therapy to be based on more rational principles. The decreased arterial reactivity encountered in normotensive pregnancy is most likely mediated by prostaglandins; preventive therapy using low dose aspirin is an option to prevent development of proteinuria in pre-existing hypertension and provide prophylaxis against pregnancy-induced hypertension.
2 Antihypertensive therapy utilizing sympathetic inhibition with either methyldopa or α- and β-adrenoceptor blockade yields the most promising results. Vasodilation with hydralazine, calcium entry blockers (nifedipine), intravenous labetalol or diazoxide is primarily used in severely hypertensive patients. The use of orally administered nifedipine in severely hypertensive women is associated with encouraging results.
3 It is clear that women with blood pressure levels greater than 170/110 mm Hg need antihypertensive therapy for maternal safety; it remains to be proven to what extent foetal growth and welfare can be improved in women with diastolic pressure levels 85-110 mm Hg when adrenoceptor blocking agents are used for blood pressure control. Initial studies are suggestive of improved foetal growth, prevention of proteinuria and the respiratory distress syndrome but more long-term controlled studies are required.
4 In a recent study, at our institution, of foetal growth during long term antihypertensive therapy, treatment with pindolol yielded better foetal growth than therapy with atenolol. It is as yet unclear whether the ISA or β2-mediated vasodilation associated with pindolol was responsible for the improved foetal growth. Further controlled studies are indicated in hypertension in pregnancy to confirm the suggested benefits of β-adrenoceptor blocker therapy.
Keywords: hypertension, pregnancy
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Beaufils M., Uzan S., Donsimoni R., Colau J. C. Prevention of pre-eclampsia by early antiplatelet therapy. Lancet. 1985 Apr 13;1(8433):840–842. doi: 10.1016/s0140-6736(85)92207-x. [DOI] [PubMed] [Google Scholar]
- Chesley L. C. Hypertension in pregnancy: definitions, familial factor, and remote prognosis. Kidney Int. 1980 Aug;18(2):234–240. doi: 10.1038/ki.1980.131. [DOI] [PubMed] [Google Scholar]
- Lamming G. D., Broughton Pipkin F., Symonds E. M. Comparison of the alpha and beta blocking drug, labetalol, and methyl dopa in the treatment of moderate and severe pregnancy-induced hypertension. Clin Exp Hypertens. 1980;2(5):865–895. doi: 10.3109/10641968009037147. [DOI] [PubMed] [Google Scholar]
- Lubbe W. F. Hypertension in pregnancy. Pathophysiology and management. Drugs. 1984 Aug;28(2):170–188. doi: 10.2165/00003495-198428020-00005. [DOI] [PubMed] [Google Scholar]
- Moutquin J. M., Rainville C., Giroux L., Raynauld P., Amyot G., Bilodeau R., Pelland N. A prospective study of blood pressure in pregnancy: prediction of preeclampsia. Am J Obstet Gynecol. 1985 Jan 15;151(2):191–196. doi: 10.1016/0002-9378(85)90010-9. [DOI] [PubMed] [Google Scholar]
- Naden R. P., Redman C. W. Antihypertensive drugs in pregnancy. Clin Perinatol. 1985 Oct;12(3):521–538. [PubMed] [Google Scholar]
- Nylund L., Lunell N. O., Lewander R., Sarby B., Thornström S. Labetalol for the treatment of hypertension in pregnancy. Pharmacokinetics and effects on the uteroplacental blood flow. Acta Obstet Gynecol Scand Suppl. 1984;118:71–73. doi: 10.3109/00016348409157127. [DOI] [PubMed] [Google Scholar]
- Rubin P. C., Butters L., Clark D. M., Reynolds B., Sumner D. J., Steedman D., Low R. A., Reid J. L. Placebo-controlled trial of atenolol in treatment of pregnancy-associated hypertension. Lancet. 1983 Feb 26;1(8322):431–434. [PubMed] [Google Scholar]
- Socol M. L., Weiner C. P., Louis G., Rehnberg K., Rossi E. C. Platelet activation in preeclampsia. Am J Obstet Gynecol. 1985 Feb 15;151(4):494–497. doi: 10.1016/0002-9378(85)90276-5. [DOI] [PubMed] [Google Scholar]
- Walsh S. W. Preeclampsia: an imbalance in placental prostacyclin and thromboxane production. Am J Obstet Gynecol. 1985 Jun 1;152(3):335–340. doi: 10.1016/s0002-9378(85)80223-4. [DOI] [PubMed] [Google Scholar]