Disclosures: Garovic reports no relevant financial disclosures. Please see the statement for all other authors’ relevant financial disclosures.
December 15, 2021
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AHA: For hypertensive disorders of pregnancy, treat high BP, individualize therapy

Disclosures: Garovic reports no relevant financial disclosures. Please see the statement for all other authors’ relevant financial disclosures.
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According to a new scientific statement published in Hypertension, high BP should be treated during pregnancy, and treatment should be individualized to each patient.

Despite the many recommendations published on the treatment of hypertensive disorders of pregnancy, there had been little agreement on whether and when to initiate antihypertensive treatment, the authors wrote.

AHA guidelines on treating hypertensive disorders of pregnancy
Hypertensive disorders of pregnancy are the second-leading cause of maternal death and providers should take risk factors into account and individualize treatment. Infographic content were derived from Garovic VD, et al. Hypertension. 2021;doi:10.1161/HYP.0000000000000208.

An American Heart Association writing committee, chaired by Vesna D. Garovic, MD, PhD, professor of medicine, chair of the division of nephrology and hypertension with a joint appointment in the department of obstetrics and gynecology at Mayo Clinic, reviewed the existing knowledge base on hypertensive disorders of pregnancy and provided recommendations for screening and antihypertensive treatment initiation.

Antihypertensive therapy during pregnancy safe, effective

“For decades, the benefits of blood pressure treatment for pregnant women were unclear. And there were concerns about fetal well-being from exposure to antihypertensive medications,” Garovic said in a press release. “Through our comprehensive review of the existing literature, it is reassuring to see emerging evidence that treating high blood pressure during pregnancy is safe and effective and may be beneficial at lower thresholds than previously thought. Now, we have the current statement focused on hypertension during pregnancy to help inform optimal treatment and future research.”

According to the statement, most guidelines agree that hypertension in pregnancy is defined as BP of 140/90 mm Hg or more; however, there is inconsistency regarding the threshold for initiation of antihypertensive treatment due to a lack of certainty of its benefits for this population.

“Given the rising number of cases of hypertension during pregnancy, together with hypertension-related complications, the problem has become a public health crisis, particularly among women from racially and ethnically diverse backgrounds,” Garovic said in the release.

According to the statement, hypertensive disorders of pregnancy are the second-leading cause of maternal death behind maternal hemorrhage and are a significant cause of short- and long-term maternal and offspring morbidity worldwide.

In addition, prior research indicated that hypertension develops faster among women who experienced hypertensive disorders of pregnancy, up to 10 years earlier, compared with women with normotensive pregnancies.

The writing group stated that a lower treatment threshold for hypertensive disorders of pregnancy than what is currently posited by the American College of Obstetricians and Gynecologists may prevent adverse hypertensive end-organ complications.

Specifically, reclassifying hypertensive disorders of pregnancy with the lower American College of Cardiology/AHA diagnostic threshold of 130/80 mm Hg or more may better identify women at risk for developing preeclampsia and adverse fetal/neonatal outcomes.

In the statement, physicians are encouraged to individualize treatment decisions and take other risk factors into account.

Areas for future research

According to the statement, antihypertensive treatment, prevention of seizures and timed birth with close fetal monitoring are the current therapeutic options for women with preeclampsia and the superiority of any of the widely used antihypertensives has not been demonstrated. In addition, combination therapies have not been tested in this population.

The writing committee added that since there are no longer concerns regarding the effect of BP treatment on the fetus, more data are needed evaluating the adequate levels of BP control during the postpartum period, due to the risk for maternal morbidity and mortality during this time.

“Future clinical trials are needed to address questions about when to begin treatment for high blood pressure during pregnancy,” Garovic said in the release. “Also, close collaboration between the American Heart Association and American College of Obstetricians and Gynecologists will be instrumental in optimizing diagnosis and treatment of hypertension during pregnancy and in improving immediate and long-term outcomes for many women who develop hypertension during pregnancy.”

Please see the AHA Scientific Statement for the full details on the new recommendations.

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