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Management of Chronic Hypertension During Pregnancy

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1 Credit CME

Among nonpregnant women of reproductive age in the US, the prevalence of chronic hypertension (cHTN) is approximately 9%, and hypertensive disorders of pregnancy complicate approximately 5% of all pregnancies.1 Although most pregnancies among individuals with well-controlled cHTN are uncomplicated, individuals with cHTN are at increased risk for maternal morbidity (eg, hypertensive urgency, preeclampsia, kidney failure, pulmonary edema, myocardial infarction, placental abruption, gestational diabetes, stroke, death) and poor fetal/neonatal outcomes (eg, growth restriction, preterm birth, congenital anomalies, stillbirth, perinatal death).1,2 Furthermore, cHTN during pregnancy increases long-term risks for development of cardiovascular, metabolic, and cerebrovascular disease.3 Therefore, effectively diagnosing and managing cHTN before, during, and after pregnancy is imperative for optimal maternal and child health.

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Article Information

Corresponding Author: Denise J. Jamieson, MD, MPH, Department of Gynecology and Obstetrics, Emory University School of Medicine, 101 Woodruff Cir, Woodruff Memorial Research Building, Ste 4208, Atlanta, GA 30322 (djamieson@emory.edu).

Conflict of Interest Disclosures: Dr Badell reported receiving grants from the National Institutes of Health Chronic Hypertension and Pregnancy (CHAP) study site as a co-investigator during the conduct of the study. No other disclosures were reported.

References
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Azeez  O , Kulkarni  A , Kuklina  EV , Kim  SY , Cox  S .  Hypertension and diabetes in non-pregnant women of reproductive age in the United States.   Prev Chronic Dis. 2019;16:E146. doi:10.5888/pcd16.190105 PubMedGoogle ScholarCrossref
2.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics.  ACOG practice bulletin No. 203: chronic hypertension in pregnancy.   Obstet Gynecol. 2019;133(1):e26-e50. doi:10.1097/AOG.0000000000003020 PubMedGoogle ScholarCrossref
3.
Yee  LM , Miller  EC , Greenland  P .  Mitigating the long-term health risks of adverse pregnancy outcomes.   JAMA. 2022;327(5):421-422. doi:10.1001/jama.2021.23870 PubMedGoogle ScholarCrossref
4.
Whelton  PK , Carey  RM , Aronow  WS ,  et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.   J Am Coll Cardiol. 2018;71(19):2199-2269. doi:10.1016/j.jacc.2017.11.005 PubMedGoogle ScholarCrossref
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Bello  NA , Zhou  H , Cheetham  TC ,  et al.  Prevalence of hypertension among pregnant women when using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and association with maternal and fetal outcomes.   JAMA Netw Open. 2021;4(3):e213808. doi:10.1001/jamanetworkopen.2021.3808 PubMedGoogle ScholarCrossref
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Chandrasekaran  S , Levine  LD , Durnwald  CP , Elovitz  MA , Srinivas  SK .  Excessive weight gain and hypertensive disorders of pregnancy in the obese patient.   J Matern Fetal Neonatal Med. 2015;28(8):964-968. doi:10.3109/14767058.2014.939624 PubMedGoogle ScholarCrossref
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Bello  NA , Woolley  JJ , Cleary  KL ,  et al.  Accuracy of blood pressure measurement devices in pregnancy: a systematic review of validation studies.   Hypertension. 2018;71(2):326-335. doi:10.1161/HYPERTENSIONAHA.117.10295 PubMedGoogle ScholarCrossref
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American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Society for Maternal-Fetal Medicine.  Indications for outpatient antenatal fetal surveillance: ACOG Committee Opinion, Number 828.   Obstet Gynecol. 2021;137(6):e177-e197. doi:10.1097/AOG.0000000000004407 PubMedGoogle ScholarCrossref
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Magee  LA , Singer  J , von Dadelszen  P ; CHIPS Study Group.  Less-tight versus tight control of hypertension in pregnancy.   N Engl J Med. 2015;372(24):2367-2368.PubMedGoogle Scholar
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Tita  AT , Szychowski  JM , Boggess  K ,  et al; Chronic Hypertension and Pregnancy (CHAP) Trial Consortium.  Treatment for mild chronic hypertension during pregnancy.   N Engl J Med. Published online April 2, 2022. doi:10.1056/NEJMoa2201295PubMedGoogle ScholarCrossref
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