Use of Nifedipine in the Hypertensive Diseases of Pregnancy

1994 ◽  
Vol 28 (12) ◽  
pp. 1371-1378 ◽  
Author(s):  
Anne C. Levin ◽  
Paul L. Doering ◽  
Randy C. Hatton
Keyword(s):  
Blood Pressure ◽  
English Language ◽  
Antihypertensive Agents ◽  
Organ Damage ◽  
Initial Therapy ◽  
Current Data ◽  
Chronic Hypertension ◽  
Hypertension In Pregnancy ◽  
Uteroplacental Blood Flow ◽  
In Pregnancy

OBJECTIVE: To review the available data about the use of nifedipine to treat hypertension in pregnancy. DATA SOURCES: All English language cases and studies published after 1984 and indexed in MEDLINE, Excerpta Medica, and BIOSIS PREVIEWS under the headings nifedipine, hypertension in pregnancy, uteroplacental blood flow, maternal/fetal hemodynamics, preeclampsia, and pregnancy outcome. MAIN OUTCOME MEASURES: The primary outcome indicators included the safety and antihypertensive efficacy of nifedipine in pregnancy; the effects of nifedipine on maternal/fetal hemodynamics; and the effect, if any, of nifedipine on perinatal outcome. CONCLUSIONS: Traditional drug therapy choices for hypertension in pregnancy continue to be hydralazine for acute reduction of blood pressure and methyldopa for the management of chronic hypertension. Current data indicate that nifedipine is an appropriate second-line antihypertensive medication in pregnancy, but more clinical trials are needed before it can be considered an appropriate choice for initial therapy. As do other antihypertensive agents, nifedipine provides maternal benefit by lowering blood pressure and reducing the risk of cerebral hemorrhage and end-organ damage. However, perinatal benefit of nifedipine remains to be established.

Hypertensive Disorders in Pregnancy

2017 ◽  
Author(s):  
Kavitha Vellanki ◽  
Susan Hou
Keyword(s):  
Blood Pressure ◽  
Organ Damage ◽  
The United States ◽  
Blood Pressure Target ◽  
Maternal Complications ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Few Data ◽  
In Pregnancy ◽  
New Onset

Hypertensive disorders are the second leading cause of maternal mortality in the United States. Hypertension in pregnancy is defined as blood pressure greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hg diastolic, measured on at least two separate occasions. Preeclampsia, as per the new guidelines, is characterized by the new onset of hypertension and either proteinuria or other end-organ dysfunction, more often after 20 weeks of gestation in a previously normotensive pregnant woman. New-onset proteinuria is not required for diagnosis of preeclampsia if there is evidence of other end-organ damage—a change from previous classifications. Although no screening test has yet proven accurate enough to predict preeclampsia, the use of a combination of the serologic factors seems promising. There are few data to support any specific blood pressure target in pregnancy. Although there is a general consensus on treating severe hypertension in pregnancy, there is a difference of opinion on treating mild to moderate hypertension in pregnancy. Avoiding uteroplacental ischemia and minimizing fetal exposure to adverse effects of medications are as important as avoiding maternal complications from high blood pressure during pregnancy. This review contains 2 figures, 4 tables, and 73 references.

scholarly journals Hipertensi pada Kehamilan

2019 ◽  
Vol 2 (2) ◽  
pp. 27
Author(s):  
Haidar Alatas
Keyword(s):  
Gestational Hypertension ◽  
Organ Damage ◽  
Antihypertensive Drug Therapy ◽  
Chronic Hypertension ◽  
First Line ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Hipertensi pada kehamilan sering terjadi (6-10 %) dan meningkatkan risiko morbiditas dan mortalitas pada ibu, janin dan perinatal. Pre-eklampsia/eklampsia dan hipertensi berat pada kehamilan risikonya lebih besar. Hipertensi pada kehamilan dapat digolongkan menjadi pre-eklampsia/ eklampsia, hipertensi kronis pada kehamilan, hipertensi kronis disertai pre-eklampsia, dan hipertensi gestational. Pengobatan hipertensi pada kehamilan dengan menggunakan obat antihipertensi ternyata tidak mengurangi atau meningkatkan risiko kematian ibu, proteinuria, efek samping, operasi caesar, kematian neonatal, kelahiran prematur, atau bayi lahir kecil. Penelitian mengenai obat antihipertensi pada kehamilan masih sedikit. Obat yang direkomendasikan adalah labetalol, nifedipine dan methyldopa sebagai first line terapi. Penatalaksanaan hipertensi pada kehamilan memerlukan pendekatan multidisiplin dari dokter obsetri, internis, nefrologis dan anestesi. Hipertensi pada kehamilan memiliki tingkat kekambuhan yang tinggi pada kehamilan berikutnya. Hypertension complicates 6% to 10% of pregnancies and increases the risk of maternal, fetal and perinatal morbidity and mortality. Preeclampsia / eclampsia and severe hypertension in pregnancy are at greater risk. Four major hypertensive disorders in pregnancy have been described by the American College of Obstetricians and Gynecologists (ACOG): chronic hypertension; preeclampsia-eclampsia; chronic hypertension with superimposed preeclampsia; and gestational hypertension. The current review suggests that antihypertensive drug therapy does not reduce or increase the risk of maternal death, proteinuria, side effects, cesarean section, neonatal and birth death, preterm birth, or small for gestational age infants. The quality of evidence was low. Recommendations for treatment of hypertension in pregnancy are labetalol, nifedipine and methyldopa as first line drugs therapy. Although the obstetrician manages most cases of hypertension during pregnancy, the internist, cardiologist, or nephrologist may be consulted if hypertension precedes conception, if end organ damage is present, or when accelerated hypertension occurs. Women who have had preeclampsia are also at increased risk for hypertension in future pregnancies.

scholarly journals The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy

2018 ◽  
Vol 11 ◽  
pp. 92-98 ◽  
Author(s):  
E. Shawkat ◽  
H. Mistry ◽  
C. Chmiel ◽  
L. Webster ◽  
L. Chappell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Hypertension ◽  
Hypertension In Pregnancy ◽  
In Pregnancy

scholarly journals 22 The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy

2016 ◽  
Vol 6 (3) ◽  
pp. 147-148
Author(s):  
Emma Shawkat ◽  
Hitesh Mistry ◽  
Catherine Chmiel ◽  
Edward Johnstone ◽  
Jenny Myers
Keyword(s):  
Blood Pressure ◽  
Chronic Hypertension ◽  
Hypertension In Pregnancy ◽  
In Pregnancy

Abstract 541: Blood Pressure at 20 Weeks’ Gestation is Predictive of Hypertensive Disease in Pregnancy and is Independently Associated With 5-year Hypertensive Morbidity Post Delivery

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Asako Mito ◽  
Naoko Arata ◽  
Dongmei Qiu ◽  
Naoko Sakamoto ◽  
Yukihiro Oya ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Odds Ratio ◽  
Multiple Logistic Regression Analysis ◽  
Previous History ◽  
Antihypertensive Agents ◽  
Chronic Hypertension ◽  
Hypertensive Disease ◽  
History Of ◽  
In Pregnancy

[Background] Hypertensive disease in pregnancy (HDP) is associated with a risk of subsequent hypertension. However the influence of normotensive blood pressure (BP) during pregnancy on future BP is not clear. [Purpose] To investigate the association between BP measurements at their lowest levels in pregnancy, 20 weeks’ gestation (20 wks BP), and the risk of hypertension both ①during pregnancy and ②5 years after delivery. [Methods] A total of 1542 women who delivered singletons at the National Center for Child Health and Development and Showa University Hospital were recruited between 2003 and 2007. They were invited to undergo a physical examination 5 years after delivery. Following exclusions (see below), 772 women completed the analysis. The influence of 20 wks BP on HDP and 5-year hypertension was assessed by multiple logistic regression analysis. The odds ratio for HDP was adjusted by age at delivery, pre-pregnancy BMI, familial history of hypertension (FH), previous history of HDP and parity (Model 1) and that for subsequent hypertension was adjusted by existence of HDP in index pregnancy, age, BMI, FH and renal disease (Model 2). [Criteria] HDP was defined as sBP ≥ 140 mm Hg or dBP ≥ 90 mm Hg from 20 weeks’ gestation which remits by 12 weeks postpartum w/o proteinuria. Hypertension at physical examination was defined as average sBP ≥ 140 mm Hg or average dBP ≥ 90 mm Hg or treatment with antihypertensive agents. [Exclusion criteria] Chronic hypertension / Women who were pregnant and nursing when the physical examination was done [Results] There were 26 HDP cases and 25 cases of 5-year hypertension (HDP: 6, normotensive control: 19). ① The odds ratio (95%CI) for HDP (adjusted by Model 1) is sBP:1.11 (for every 1 mmHg rise) (1.05~1.17), dBP:1.15(1.06~1.24) and BP category defined by the American Heart Association : 5.82 (for every 1 category increase)(2.15~15.76). A positive correlation between 20 wks BP and HDP risk was observed. ② The odds ratio for subsequent hypertension (adjusted by Model 2) is sBP: 1.06 (1.01-1.11), dBP:1.15(1.06-1.24) and BP category: 4.50(1.64-12.33). 20 wks BP is associated with subsequent hypertension, independent of HDP . [Conclusions] 20 wks BP may predict both HDP and subsequent hypertension 5 years post delivery.

Screening for Hypertension in Pregnancy

1992 ◽  
Vol 8 (S1) ◽  
pp. 63-71
Author(s):  
Robert L. Goldenberg
Keyword(s):  
Blood Pressure ◽  
Pregnancy Outcome ◽  
Early Pregnancy ◽  
Chronic Hypertension ◽  
Hypertension In Pregnancy ◽  
Decrease Blood Pressure ◽  
Poor Pregnancy Outcome ◽  
In Pregnancy

AbstractThe literature dealing with screening for hypertension in pregnancy was reviewed. No level of blood pressure or any other factor provides a guarantee of no risk for the development of preeclampsia. However, higher blood pressure in early pregnancy and a failure to decrease blood pressure in midpregnancy are both associated with the development of preeclampsia. The development of proteinuria, rather than the level of blood pressure, is the best predictor of poor pregnancy outcome. Multiparas, especially those with severe chronic hypertension who develop preeclampsia, are at greatest risk of poor pregnancy outcome.

Chronic Hypertension in Pregnancy: New Concepts for Classification and Management

2018 ◽  
Vol 36 (02) ◽  
pp. 161-168 ◽  
Author(s):  
Baha Sibai ◽  
Khalil Chahine
Keyword(s):  
Blood Pressure ◽  
Low Risk ◽  
Chronic Hypertension ◽  
Hypertension In Pregnancy ◽  
New Concepts ◽  
Obstetric Population ◽  
Therapy Target ◽  
Work Up ◽  
In Pregnancy

AbstractChronic hypertension in pregnancy is traditionally classified according to degree of blood pressure (BP) elevation. Alternatively, stratifying women as high or low risk based on the etiology of hypertension, baseline work-up, and comorbid medical conditions will better inform clinicians about thresholds to initiate antihypertensive therapy, target BPs, frequency of antepartum visits, and timing of delivery. Women classified as high-risk chronic hypertension as described here require stricter BP management and more frequent follow-up visits as their associated rates of adverse maternal and/or fetal/neonatal outcomes appear higher than women classified as low-risk chronic hypertension. The latter group can in most cases be managed similarly to the general obstetric population.

Managing high blood pressure in pregnancy

1993 ◽  
Vol 31 (14) ◽  
pp. 53-56
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
High Blood Pressure ◽  
Chronic Hypertension ◽  
Pregnancy Induced Hypertension ◽  
Hypertension In Pregnancy ◽  
Arterial Blood ◽  
Induced Hypertension ◽  
In Pregnancy

Raised arterial blood pressure is common in pregnancy. Usually it is due solely to the pregnancy and resolves within days or weeks of delivery (pregnancy-induced hypertension – PIH). Occasionally it is chronic hypertension which predates or begins during pregnancy; it persists after delivery. In some women it is a mixture of both, with pregnancy-induced hypertension superimposed on existing chronic hypertension. In this article we discuss the risks to mother and fetus of hypertension in pregnancy and review its prevention and management.

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