Hypertension and pregnancy

Hypertension is the most common medical disorder encountered during pregnancy, affecting up to 10 % of all pregnancies. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. Hypertension in pregnancy includes a spectrum of conditions, including preeclampsia-eclampsia, preeclampsia superimposed on chronic hypertension, chronic hypertension, and gestational hypertension. Unlike other hypertensive pregnancy disorders, preeclampsia is a multisystem disease, its distinctive feature being either sudden onset or worsening of preexisting proteinuria. Despite significant advances in our understanding of preeclampsia, the etiology of this condition remains elusive, resulting in a failure to develop specific screening, preventive, and treatment strategies. Delivery remains the mainstay of therapy for severe forms and anticipated life-threatening complications. The most important reason for the initiation of antihypertensive treatment in these patients is to prevent maternal cerebrovascular and cardiac complications. The optimal timing and choice of therapy for hypertensive pregnancy disorders involves carefully weighing the risk-versus-benefit ratio for each individual patient, with an overall goal of improving maternal and fetal outcomes. Finally, over the past decades, it has become increasingly clear that women with a history of preeclamptic compared to normotensive pregnancies are at increased risk for cardiovascular disease later in life. In this chapter, we summarize the mechanisms thought to be involved in hypertensive pregnancy disorders, review the current treatment guidelines, and outline some newer perspectives on management, including postpartum monitoring and treatment of conventional cardiovascular risk factors in the affected women.