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Diagnosis and treatment of hypertensive disorders during pregnancy

Isabelle Fabry, T Richart, X Cheng, Lucas Van Bortel and JA Staessen (2010) ACTA CLINICA BELGICA. 65(4). p.229-236
abstract
Pregnancy is a cardiovascular and metabolic challenge to the human female body. This review summarizes current knowledge on the regulation of blood pressure and plasma volume in normal and hypertensive pregnant women. During pregnancy, systemic vascular resistance and blood pressure decrease, whereas cardiac output and blood volume increase to safeguard an adequate circulation in the utero-placental arterial bed. Hypertension affects 10% of all pregnancies and is accompanied by an increase in foetal and maternal morbidity and mortality. Hypertension in pregnancy includes a wide spectrum of conditions, including pre-eclampsia and eclampsia, pre-eclampsia superimposed on chronic hypertension, chronic hypertension, and gestational hypertension. Endothelial dysfunction, oxidative stress and an exaggerated inflammatory response are features related to hypertensive disorders. Microangiopathic disorders can easily mimic hypertensive disorders during pregnancy. Although they have some symptoms in common, they require another type of management. To reduce the risk of maternal and foetal complications due to haemodynamic maladaptations, the current management includes rest at home or in the hospital, close monitoring of maternal and foetal signs and symptoms, early start of antihypertensive therapy, and timely delivery regarding maternal and foetal survival chances. Thresholds to initiate blood pressure lowering treatment during pregnancy are 160 mmHg systole or 110 mmHg diastole. Below these thresholds, treatment must be individualized because current evidence does not support aggressive medical interventions. Alpha-methyldopa and dihydropyridinic calcium channel blockers are among the recommended antihypertensives.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
pregnancy, ATRIAL-NATRIURETIC-PEPTIDE, haemodynamics, hypertension, BLOOD-PRESSURE, ANTIPHOSPHOLIPID SYNDROME, PREECLAMPTIC PREGNANCIES, HEMODYNAMIC-CHANGES, VASCULAR-TONE, NITRIC-OXIDE, HEART-RATE, VOLUME, WOMEN
journal title
ACTA CLINICA BELGICA
Acta Clin. Belg.
volume
65
issue
4
pages
229 - 236
Web of Science type
Article
Web of Science id
000282621200001
JCR category
MEDICINE, GENERAL & INTERNAL
JCR impact factor
0.532 (2010)
JCR rank
104/151 (2010)
JCR quartile
3 (2010)
ISSN
0001-5512
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1167037
handle
http://hdl.handle.net/1854/LU-1167037
date created
2011-02-23 14:20:44
date last changed
2016-12-19 15:46:40
@article{1167037,
  abstract     = {Pregnancy is a cardiovascular and metabolic challenge to the human female body. This review summarizes current knowledge on the regulation of blood pressure and plasma volume in normal and hypertensive pregnant women. During pregnancy, systemic vascular resistance and blood pressure decrease, whereas cardiac output and blood volume increase to safeguard an adequate circulation in the utero-placental arterial bed. Hypertension affects 10\% of all pregnancies and is accompanied by an increase in foetal and maternal morbidity and mortality. Hypertension in pregnancy includes a wide spectrum of conditions, including pre-eclampsia and eclampsia, pre-eclampsia superimposed on chronic hypertension, chronic hypertension, and gestational hypertension. Endothelial dysfunction, oxidative stress and an exaggerated inflammatory response are features related to hypertensive disorders. Microangiopathic disorders can easily mimic hypertensive disorders during pregnancy. Although they have some symptoms in common, they require another type of management.
To reduce the risk of maternal and foetal complications due to haemodynamic maladaptations, the current management includes rest at home or in the hospital, close monitoring of maternal and foetal signs and symptoms, early start of antihypertensive therapy, and timely delivery regarding maternal and foetal survival chances. Thresholds to initiate blood pressure lowering treatment during pregnancy are 160 mmHg systole or 110 mmHg diastole. Below these thresholds, treatment must be individualized because current evidence does not support aggressive medical interventions. Alpha-methyldopa and dihydropyridinic calcium channel blockers are among the recommended antihypertensives.},
  author       = {Fabry, Isabelle and Richart, T and Cheng, X and Van Bortel, Lucas and Staessen, JA},
  issn         = {0001-5512},
  journal      = {ACTA CLINICA BELGICA},
  keyword      = {pregnancy,ATRIAL-NATRIURETIC-PEPTIDE,haemodynamics,hypertension,BLOOD-PRESSURE,ANTIPHOSPHOLIPID SYNDROME,PREECLAMPTIC PREGNANCIES,HEMODYNAMIC-CHANGES,VASCULAR-TONE,NITRIC-OXIDE,HEART-RATE,VOLUME,WOMEN},
  language     = {eng},
  number       = {4},
  pages        = {229--236},
  title        = {Diagnosis and treatment of hypertensive disorders during pregnancy},
  volume       = {65},
  year         = {2010},
}

Chicago
Fabry, Isabelle, T Richart, X Cheng, Lucas Van Bortel, and JA Staessen. 2010. “Diagnosis and Treatment of Hypertensive Disorders During Pregnancy.” Acta Clinica Belgica 65 (4): 229–236.
APA
Fabry, I., Richart, T., Cheng, X., Van Bortel, L., & Staessen, J. (2010). Diagnosis and treatment of hypertensive disorders during pregnancy. ACTA CLINICA BELGICA, 65(4), 229–236.
Vancouver
1.
Fabry I, Richart T, Cheng X, Van Bortel L, Staessen J. Diagnosis and treatment of hypertensive disorders during pregnancy. ACTA CLINICA BELGICA. 2010;65(4):229–36.
MLA
Fabry, Isabelle, T Richart, X Cheng, et al. “Diagnosis and Treatment of Hypertensive Disorders During Pregnancy.” ACTA CLINICA BELGICA 65.4 (2010): 229–236. Print.