Hypertension in pregnancy is when the pressure is above 140/90 (mmHg). Blood pressure should be taken and documented in two or more readings, at least four or six hours apart.

In general, hypertensive disorders affect an increasing percentage that reaches 5% to 10% of women during pregnancy. Preeclampsia is one of the leading causes of pregnancy-related death.

Sometimes hypertension is present in the woman before pregnancy and in others it develops during pregnancy. This is how we talk about:

Chronic hypertension. When we have an increase in blood pressure before pregnancy or before the 20th week of pregnancy. Because high blood pressure usually has no symptoms, it can be difficult to know exactly when it started.

Chronic hypertension with preeclampsia. This condition occurs when chronic hypertension leads to worsening of high blood pressure during pregnancy and development of proteinuria or other complications.

Gestational hypertension. Appearance of hypertension after the 20th week of pregnancy. There is no excess protein in the urine or other signs of organ damage. Gestational hypertension can lead to preeclampsia.

Pre-eclampsia. Preeclampsia occurs when hypertension develops after the 20th week of pregnancy with the appearance of proteinuria and signs of damage to other organs.

Eclampsia. Untreated preeclampsia can lead to serious and even fatal complications for mother and baby.

(HELLP) syndrome. The hemolysis, elevated liver enzymes, low platelet syndrome is a form of preeclampsia. Which progresses to a life-threatening syndrome of liver failure and worsening thrombocytopenia in the presence of only mild to moderate hypertension.

Pre-eclampsia of labor. Occurrence of preeclampsia after delivery. It is diagnosed within 48 hours after birth, but can occur up to 6 weeks later. It is a serious medical condition and can occur in women with no history of preeclampsia during pregnancy. The symptoms are similar to preeclampsia.

High blood pressure can cause risks during pregnancy such as:

• Less blood flow to the placenta. (intrauterine growth restriction), low birth weight or premature birth.
• Increased risk of placental abruption.
• Restriction of intrauterine growth of the fetus.
• Damage to other organs.
• Premature Labor.

• Future cardiovascular disease. The risk of future cardiovascular disease is higher in cases of preeclampsia.

The usual symptoms of preeclampsia are the appearance of proteinuria, severe headaches, visual disturbances, pain in the upper part of the stomach and under the ribs mainly on the right, nausea, vomiting, shortness of breath, sudden weight gain and swelling (face, hands, feet).

Useful Tips to avoid High Blood Pressure during pregnancy:

The woman before starting a pregnancy or when it is in its first weeks should visit her gynecologist and if she already has arterial hypertension, she should schedule an appointment with a cardiologist who has experience in the management of pregnancies involved with hypertension.

–Regular doctor’s appointments they will check the blood pressure of the mother and the development of the fetus at each visit and laboratory tests will be done accordingly. These will help in early diagnosis – regulation of hypertension or pre-eclampsia of pregnancy and thus in more effective treatment.

–Healthy diet.

–Regular physical activity: It helps to better regulate blood pressure.

–Body Weight: Maintaining a healthy body weight before and during pregnancy reduces the risk of developing gestational hypertension.

–Stop smoking and alcohol: Both raise blood pressure.

–Stress Management: with gentle exercise, yoga, Ms.

–Taking appropriate antihypertensive treatment and blood pressure monitoring with a home sphygmomanometer.

–Direct communication with the doctor if blood pressure is irregular or symptoms of pre-eclampsia occur.

Usually the pre-eclampsia appears in:

• First delivery.
• Existence of pre-eclampsia in a previous pregnancy.
• Chronic arterial hypertension, chronic kidney disease.
• History of thrombophilia.
• Pregnancy with twins or triplets.
• In vitro fertilization.
• Family history of pre-eclampsia.
• Diabetes mellitus.
• Obesity.
• Autoimmune diseases.
• Pregnant over 40 years old.

Treatment

The choice of antihypertensive drugs in pregnancy is limited by concerns about the safety of the fetus. In addition to safety, an ideal antihypertensive agent should gradually lower blood pressure without compromising uterine blood flow to the fetus.

Methyldopa is a safe antihypertensive agent with a proven safety record in pregnancy. Calcium channel blockers are increasingly used for severe hypertension resistant to other drugs. In particular, nifedipine has been shown to reduce blood pressure and improve kidney function without affecting blood flow in the umbilical artery. Intravenous hydralazine is recommended for the treatment of severe hypertension in women for immediate action.

Beta-blockers appear to control blood pressure fairly safely when given in the third trimester with labetalol as the main representative. The main concerns regarding the use of β-blockers stem from evidence of intrauterine growth retardation and low placental weight documented when atenolol was used in the second trimester. Beta-blockers can cause adverse effects such as fetal bradycardia, impaired fetal compensatory response to hypoxia, and neonatal hypoglycemia. Diuretics are used in the case of renal failure of congestive heart failure, but causing hyponatremia, hypokalemia, and hyperuricemia.

Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and renin inhibitors are contraindicated in pregnancy.
Finally, in severe resistant hypertension, in addition to hydralazine, directly acting vasodilators can be used, which can cause complications, such as excessive hypotension (sodium nitroprusside and diazoxide) and cyanide poisoning (sodium nitroprusside only), making them emergency agents.
Intravenous magnesium sulfate therapy is effective for seizure prophylaxis in women with severe preeclampsia and eclampsia.

Conclusion

The ultimate goal of treating hypertension in pregnancy is to deliver a healthy newborn without compromising the mother’s health. Early diagnosis and close monitoring of both mother and fetus is crucial. Antihypertensive drugs should be used judiciously and the risks to the fetus from intrauterine exposure should be carefully evaluated. Severe preeclampsia represents an obstetric emergency, with potentially fatal outcomes for both the fetus and the mother. The definitive treatment for preeclampsia is delivery. An important feature of preeclampsia is its unpredictable clinical course. Ideally, high-risk patients should be evaluated early in pregnancy by an obstetrician in collaboration with a cardiologist with special expertise in this area.

Our heart is the source of our life. September is dedicated to World Heart Day, let’s remember how important it is to take care of our heart every day. A healthy heart contributes to more moments of happiness and well-being with our loved ones.