Document Detail


How to manage hypertension in pregnancy effectively.
MedLine Citation:
PMID:  21545480     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in both well and under-resourced settings. Maternal, fetal, and neonatal complications of the HDP are concentrated among, but not limited to, women with pre-eclampsia. Pre-eclampsia is a systemic disorder of endothelial cell dysfunction and as such, blood pressure (BP) treatment is but one aspect of its management. The most appropriate BP threshold and goal of antihypertensive treatment are controversial. Variation between international guidelines has more to do with differences in opinion rather than differences in published data. For women with severe hypertension [defined as a sustained systolic BP (sBP) of ≥160 mmHg and/or a diastolic BP (dBP) of ≥110 mmHg], there is consensus that antihypertensive therapy should be given to lower the maternal risk of central nervous system complications. The bulk of the evidence relates to parenteral hydralazine and labetalol, or to oral calcium channel blockers such as nifedipine capsules. There is, however, no consensus regarding management of non-severe hypertension (defined as a sBP of 140-159 mmHg or a dBP of 90-109 mmHg), because the relevant randomized trials have been underpowered to define the maternal and perinatal benefits and risks. Although antihypertensive therapy may decrease the occurrence of BP values of 160-170/100-110 mmHg, therapy may also impair fetal growth. The potential benefits and risks do not seem to be associated with any particular drug or drug class. Oral labetalol and methyldopa are used most commonly, but many different β-adrenoceptor blockers and calcium channel blockers have been studied in clinical trials.
Authors:
Laura A Magee; Edgardo Abalos; Peter von Dadelszen; Baha Sibai; Tom Easterling; Steve Walkinshaw;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  British journal of clinical pharmacology     Volume:  72     ISSN:  1365-2125     ISO Abbreviation:  Br J Clin Pharmacol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-09     Completed Date:  2011-10-13     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  7503323     Medline TA:  Br J Clin Pharmacol     Country:  England    
Other Details:
Languages:  eng     Pagination:  394-401     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.
Affiliation:
BC Women's Hospital and Heath Centre and University of British Columbia, 4500 Oak Street, Room D213, Vancouver, BC V6H 3N1, Canada. LMagee@cw.bc.ca
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Antihypertensive Agents / therapeutic use*
Calcium Channel Blockers / therapeutic use
Female
Humans
Hypertension, Pregnancy-Induced / drug therapy*
Pregnancy
Pregnancy Complications, Cardiovascular / drug therapy*
Grant Support
ID/Acronym/Agency:
//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 0/Calcium Channel Blockers
Investigator
Investigator/Affiliation:
L A Magee / ; E Asztalos / ; P von Dadelszen / ; E Hutton / ; A Gafni / ; A Gruslin / ; M Helewa / ; T Hoac / ; S K Lee / ; A G Logan / ; J Menzies / ; J M Moutquin / ; K Murphy / ; E Rey / ; S Ross / ; I Schweitzer / ; J Singer / ; J Sanchez /
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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