Antihypertensive treatment

This chapter reviews use of antihypertensive drugs in pregnancy to rapidly control severe hypertension, treat primary or secondary chronic hypertension, and control blood pressure in preeclampsia. Summarized are drugs’ pharmacology, safety, and systematic reviews of their efficacy. Blood pressure control does not appear to prevent superimposed preeclampsia, or lessen the incidence of placental abruption. By contrast, treatment prevents severe or accelerated hypertension, perhaps decreasing or delaying the need for hospitalization or urgent early delivery. Several agents effectively control hypertension with acceptable risks to mother and fetus, while ACE inhibitors and angiotensin receptor blockers are contraindicated, especially after early pregnancy. Desperately needed are adequately powered prospective clinical trials that distinguish between women with essential hypertension, transient hypertension, or preeclampsia, and stratify treatment by severity of hypertension and by gestational age. Such trials should include systematic assessment of maternal and uteroplacental hemodynamics, fetal well-being, and long-term postnatal functional and developmental outcomes.