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Hypertension in pregnancy: is it time for a new approach to treatment?

Moser, Marvina; Brown, Catherine M.b; Rose, Carl H.c; Garovic, Vesna D.b

doi: 10.1097/HJH.0b013e3283536319

Hypertensive disorders represent major causes of pregnancy-related maternal mortality worldwide. The current definition and treatment recommendations for elevated blood pressure (BP) during pregnancy in the United States have remained unchanged for many years, unlike the recommendations for hypertension treatment in the general population. Clinical studies have provided convincing evidence that women with hypertensive pregnancy disorders are at both immediate and long-term risk for cardiovascular complications; these findings suggest that consideration be given to lowering the presently recommended BP thresholds, both for the initiation of therapy and for therapeutic targets, and to simplifying the approach to the management of elevated BP in pregnancy. This review focuses on the current treatment strategies for hypertensive pregnancy disorders, new developments in the field of hypertension, in general, and in pregnant patients, in particular, and their potential impact on contemporary BP goals and the use of specific antihypertensive medications in pregnancy.

aDepartment of Medicine/Cardiology, Yale University School of Medicine, New Haven, Connecticut

bDivision of Nephrology and Hypertension, Department of Medicine

cDepartment of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Correspondence to Vesna D. Garovic, MD, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.Tel: +1 507 284 3594; fax: +1 507 266 7891; e-mail:

Abbreviations: ACEI, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; BP, blood pressure; CVD, cardiovascular disease; HTN, hypertension; IHD, ischemic heart disease; IRR, incidence rate ratio; JNC, Joint National Committee; MI, myocardial infarction; NHBPEP, National High Blood Pressure Education Program; OR, odds ratio; PE, preeclampsia; RCGP, Royal College of General Practitioners; RR, relative risk; SGA, small-for-gestational-age

Received 21 March, 2011

Revised 9 December, 2011

Accepted 7 March, 2012

© 2012 Lippincott Williams & Wilkins, Inc.