Chronic hypertension Flashcards
1
Q
How is chronic hypertension defined?
A
- stage 1 hypertension (systolic blood pressure of 130–139 mm Hg or diastolic blood pressure of 80–89 mm Hg)
- stage 2 hypertension (systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more)
2
Q
What are the maternal risks of chronic hypertension in pregnancy?
A
- maternal mortality
- cerebrovascular accidents
- pulmonary edema
- renal failure
- gestational diabetes
- **fivefold to sixfold higher than in normotensive pregnant women
3
Q
How do you counsel the patient regarding fetal risks of chronic hypertension in pregnancy?
A
- Preterm delivery
- Fetal growth restriction
- Placental abruption
- Cardiac septal defects
- Hypospadias
- Esophageal atresia
4
Q
Baseline assessment for patient with chronic hypertension
A
- CBC
- CMP
- Baseline protein:creatinine or 24 hour urine protein with creatinine clearance
- EKG and Echo with other co-morbidities present
5
Q
Medications used for chronic hypertension in pregnancy:
A
Labetalol: 200-2400mg 2-3 x daily. Side effect: avoid with asthma, bradycardia, preexisting myocardial disease
Nifedipine: 30-120mg 2x daily.
Methyldopa: 500 - 3,000mg 2-4x daily. Side effect: sedation, dizziness, depression
Hydrochlorothiazide 12.5-50mg daily. Use as second or third line agent
6
Q
How do you manage a patient with chronic hypertension in pregnancy?
A
Baseline labs in the first trimester Detailed anatomic survey Fetal growth monthly Antenatal testing at 32 weeks Delivery between 39 weeks and 39 weeks and 6 days unless uncontrolled
