Antihypertensive therapy in pregnant women with chronic hypertension

Abstract

Chronic hypertension (CH) complicates the course of pregnancy in 1-2% of cases, and it is increasingly common. Compared with normotensive women, women with CH have a high risk of maternal and perinatal complications. Antihypertensive treatment of CH halves the risk of severe hypertension but does not reduce the incidence of preeclampsia or serious maternal complications, which may be due to the small number of observations in the studies conducted. In addition, the treatment of CH does not affect the mortality or morbidity of the fetus and/or newborn, regardless of the start date of antihypertensive therapy. Traditionally used antihypertensive drugs have been proven not to be teratogenic, while there may be an increase in the frequency of congenital malformations associated primarily with uncontrolled chronic hypertension. Although prescribing approved antihypertensive agents for all women during pregnancy are effective in lowering blood pressure in the most cases, it remains unclear whether there is an optimal drug for monotherapy and which combinations of antihypertensive drugs are best used. An alternative approach is to individualize treatment using maternal characteristics and blood pressure characteristics, in addition to blood pressure levels (for example, blood pressure variability), which also have prognostic value. This review examines current data on the treatment of pregnant women with CH from the perspective of current national and international recommendations. Discussion of the existing unresolved issues can serve as a basis for a personalized approach in the management and treatment of pregnant women with CH.