Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy

To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. No medication, or treatment with antihypertensive or anticonvulsant drugs. Prevention of maternal complications, and prevention of perinatal complications and death....

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Bibliographic Details
Published in:	Canadian Medical Association journal 1997-11, Vol.157 (9), p.1245-1254
Main Authors:	Rey, E, LeLorier, J, Burgess, E, Lange, I. R, Leduc, L
Format:	Article
Language:	eng
Subjects:	Antihypertensive Agents - classification Antihypertensive Agents - therapeutic use Blood pressure Blood Pressure - drug effects Canada Diastole Drugs Evidence-Based Medicine Female Humans Hypertension - diagnosis Hypertension - drug therapy Pregnancy Pregnancy Complications, Cardiovascular - diagnosis Pregnancy Complications, Cardiovascular - drug therapy Pregnancy Outcome Review Severity of Illness Index Systole Treatment Outcome
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Summary:	To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. No medication, or treatment with antihypertensive or anticonvulsant drugs. Prevention of maternal complications, and prevention of perinatal complications and death. Pertinent articles published from 1962 to September 1996 retrieved from the Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews and from MEDLINE; additional articles retrieved through a manual search of bibliographies; and expert opinion. Recommendations were graded according to levels of evidence. Maternal and fetal well-being were equally valued, with the belief that treatment side effects should be minimized. Reduction in the rate of adverse perinatal outcomes, including death. Potential side effects of antihypertensive drugs include placental hypoperfusion, intrauterine growth retardation and long-term effects on the infant. A systolic blood pressure greater than 169 mm Hg or a diastolic pressure greater than 109 mm Hg in a pregnant woman should be considered an emergency and pharmacologic treatment with hydralazine, labetalol or nifedipine started. Otherwise, the thresholds at which to start antihypertensive treatment are a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg in women with gestational hypertension without proteinuria or pre-existing hypertension before 28 weeks' gestation, those with gestational hypertension and proteinuria or symptoms at any time during the pregnancy, those with pre-existing hypertension and underlying conditions or target-organ damage, and those with pre-existing hypertension and superimposed gestational hypertension. The thresholds in other circumstances are a systolic pressure of 150 mm Hg or a diastolic pressure of 95 mm Hg. For nonsevere hypertension, methyldopa is the first-line drug; labetalol, pindolol, oxprenolol and nifedipine are second-line drugs. Fetal distress attributed to placental hypoperfusion is rare, and long-term effects on the infant are unknown. Magnesium sulfate is recommended for the prevention and treatment of seizures. The guidelines are more precise but compatible with those from the US and Australia.
ISSN:	0008-4409 0820-3946 1488-2329