#203 Chronic Hypertension in Pregnancy Flashcards
Chronic hypertension is present in what % of pregnant women?
0.9-1.5%
How is chronic hypertension in pregnancy defined?
Hypertension (140/90) diagnosed or present before pregnancy or before 20wks of gestation; or hypertension diagnosed for the first time during pregnancy that does not resolve in the typical postpartum period
What are the new criteria for diagnosing hypertension in adults/blood pressure categories (since 2018)?
Normal: <120/80
Elevated: SBP 120-129 and DBP <80
Stage 1 HTN: SBP 130-139 or DBP 80-89
Stage 2 HTN: SBP 140 or more or DBP of 90 or more
If patient diagnosed with Stage 1 HTN per ACC/AHA definitions prior to conception, (eg bps 130s/80s), would you manage them as cHTN or non hypertensive?
Reasonable to manage as cHTN
Is it possible to have gHTN in women with elevated bps prior to 20 wks?
Yes, 20-wk convention should not be used dogmatically, but rather for orientation while maintaining clinical judgment.
At what point during gestation does the blood pressure nadir?
16-18wks
How is the systemic vascular resistance changed early in pregnancy?
Decreases by 30%
How does the blood pressure change by 7wks of pregnancy?
Decreases by 10%
Is systolic or diastolic decreased more during pregnancy?
Diastolic is decreased more (by as much as 20mmHg)
What % of women with cHTN have proteinuria at baseline? What is the cause of the proteinuria?
11%. HTN -related nephrosclerosis or, less frequently, undiagnosed CKD
HTN persisting longer than what amount of time may be reclassified as chronic instead of gestational?
12 weeks
What % of cHTN is essential hypertension and what % is secondary hypertension?
86-89% essential
11-14% secondary
What is essential HTN?
HTN due to unknown cause
What is secondary HTN?
Related to underlying renal, endocrine, or vascular conditions
What is the definition of severe HTN during pregnancy?
At or above 160mmHg systolic bp or 110mmHg for diastolic bp.
Does caffeine affect blood pressure?
Yes, can temporarily increase blood pressure. Should not have caffeine 30 mins prior to measure of bp
Does tobacco affect blood pressure?
Yes, can temporarily increase blood pressure. Should not have tobacco 30 mins prior to measure of bp
How do you know if a blood pressure cuff is appropriately sized?
A length 1.5 times the upper arm circumference or a cuff with a bladder that encircles at least 80% of the arm and width of at least 40% of arm circumference
How should a patient be positioned for a blood pressure reading?
Sitting with legs uncrossed and back supported with arm at heart height
Will a blood pressure cuff that is too small read an overestimation or underestimation bp?
Overestimation of actual blood pressure
How should you measure a blood pressure if it needs to be taken in a recumbent position,?
Taken in the left lateral decubitus position and the cuff should be at the level of the right atrium
What % of women with cHTN will depevelop superimposed preeclampsia?
20-50%.
In women with end-organ disease or secondary HTN, what is the risk of superimposed PEC?
As high as 75%
Is preeclampsia or superimposed preeclampsia worse?
Superimposed. Usually has earlier onset, be more severe, and prognosis for the woman and her fetus is worse
Which women are at higher risk of superimposed preeclampsia?
African American, obese, smoke, have had HTN for 4 years or more, have a diastolic bp higher than 100mmHg at baseline, and have a history of preeclampsia
What is the definition of white coat hypertension?
Elevated blood pressure primarily in the presence of health care providers (may account up to 15% of individuals with office HTN)
Compared to a normotensive pregnant woman, what fold increase risk does a woman with cHTN have for CVA, pulmonary edema, renal failure?
fivefold to sixfold increase
What is the incidence of gestational diabetes in women with cHTN vs those without cHTN?
Incidence of gestational diabetes in patients with cHTN = 8.1%, in those without cHTN = 2.3%
Does cHTN affect the risk of postpartum hemorrhage?
Twice the risk
Does cHTN affect the rate of preterm delivery? How?
Increases incidence of indicated preterm delivery, but does not appear to increase rate of spontaneous preterm delivery. 28% incidence of preterm delivery
What is the incidence of low birth weight among women with cHTN?
17%
For women with severe hypertension, end-organ disease, or secondary HTN has what risk of fetal growth restriction, preterm delivery, placental abuprtion, perinatal death?
FGR: 25-40%
Preterm delivery: 67%
Placental abruption: 8-20%
Perinatal death: 11%
What is the risk of fetal growth restriction in patients with superimposed preeclampsia?
As high as 50%
What is the relative risk of perinatal mortality in women with superimposed preeclampsia compared to those with uncomplicated chronic hypertension?
3.6
What are the maternal risks of chronic HTN in pregnancy?
Death, stroke, pulmonary edema, renal insufficiency and failure, myocardial infarction, preeclampsia, placental abruption, cesarean delivery, postpartum hemorrhage, gestational diabetes
What are the fetal and neonatal risk of cHTN?
Stillbirth or perinatal, death, growth restriction, preterm birth, congenital anomalies (eg, heart defects, hypospadias, esophageal atresia)?
Does cHTN increase the risk of congenital anomalies? If so, which?
Yes. Heart defects, hypospadias, esophageal atresia.
What are the risks of exposure to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers during first trimester?
Risk of malformations (eg, renal dysgenesis, calvarial hypoplasia) and fetal growth restriction
What tests should be sent for baseline evaluation for chronic hypertension in pregnancy?
AST, ALT, creatinine, electrolytes, BUN, CBC, spot Ur Pr:Cr or 24hr urine total protein and creatinine as appropriate, EKG or echocardiogram as appropriate
What is the first end-organ typically affected by chronic hypertension?
Kidneys