Chapter 12: Hypertensive Disorders

INTRODUCTION

Prevalence and Relevance

Hypertension is the most frequent reason for office visits in the general population,¹ as well as the most common medical condition complicating up to 10% of pregnancies.^2,3,4,5 The incidence of hypertension has increased significantly over the last 10 years, with an estimate of 40% to 50% rise,^5,6 and therefore, the above figures may be understated. This goes hand in hand with an increase in obesity rates in the United States, which may subsequently lead to higher incidence of diabetes mellitus.^6,7 Other possible reasons for the increase in hypertension in pregnancy include the increased rate of multiple gestation secondary to assisted reproductive technology and increase in the age of pregnant women because of delay in having children.

Hypertension is the second most common cause of maternal death in the United States⁸ and African American women have a fourfold increase in mortality rate.⁹ The mortality rate is also increased in women over the age of 35 years.¹⁰

Table 12-1 summarizes the potential adverse effects and maternal and fetal complications of hypertension.

Hypertension in Pregnancy Task Force Report

The Task Force on hypertension in pregnancy comprised 17 clinician-scientists from the fields of obstetrics, maternal-fetal medicine, hypertension, internal medicine, nephrology, anesthesiology, physiology, and patient advocacy. These experts in the management of hypertension in pregnancy reviewed available data and provided evidence-based recommendations for clinical practice.

Its main contribution was in making evidence-based recommendations to modernize the definition and management of preeclampsia. Proteinuria was eliminated as a required criterion for diagnosis. In addition, preeclampsia is no longer classified as mild versus severe, but rather by having evidence of hypertensive pathology, and its severe form as defined by having severe features.

Management algorithms were provided accordingly for hypertensive disorders in pregnancy with and without severe features. Many of their management recommendations, particularly those for disease with severe features, provide much-needed clarity.

DEFINITIONS AND CLASSIFICATIONS

Hypertension is defined as a systolic blood pressure (BP) ≥140 mmHg or a diastolic BP ≥90 mmHg. These measurements must be made on at least two occasions, no less than 4 hours and no more than a week apart, unless severe BP ...