Esssential Hypertension in Pregnancy

Case: 34/M/L, G2P1 C/C-High blood pressure

Dx- Essential hypertension.

Question: Hx and Pe and management

Essential hypertension

-Primary elevation of blood pressure without known causes which can be ameliorated only by lifelong pharmacological therapy [Kumar& Clark 6^th edition]

Risk factor

- Genetic

- Low birthweight

- Environmental factor

a) Obesity

b) Alcohol intake

c) Sodium intake

d) Stress

e) Smoking

- Humoral mechanism (insulin resistance)

Cardiac output rises in pregnancy, however there is relative greater fall in peripheral resistance, therefore BP in pregnant woman is usually low than those not pregnant [Kumar& Clark 6^th edition]

Important history to be elicited

1) Risk factor to develop pre eclampsia

a. existing chronic medical disorders such as obesity, hypertension, diabetes mellitus, renal disease, connective tissue disease and thrombophilia,

b. Previous history of preeclampsia or eclampsia or IUGR or unexplained stillbirth

c. Family history of preeclampsia or eclampsia, and

d. Extremes of reproductive age (below 20 or above 40 years old)

Investigation

1) ECG

2) Urine dipstick test

3) Fasting Lipid profile

4) BUSE and creatinine,

Management

Non pharmacological

1. Lifestyle medication with light exercise.

2. Reduce the intake of salt and fat.

Pharmacological

1. Stop ACE inhibitor and ARBs. Atenolol can cause IUGR and Labetolol is relatively contraindicated in Asthmatic patient.

2. T. Methyldopa 250mg tds, max 3g/day or

3. T. Labetolol 100 mg tds, max 300mg tds or

4. Tab. Nifedipine 10 mg tds stat dose

** Do not give Methyl dopa together with Nifedipine.

5. High calcium supplementation of 1.5 g/day to prevent PE

6. Avoid Combined vitamins C and E (in the form of tocopherol from soybean) as it may cause IUGR

Others measurement

1. Routine ante natal check up.

2. Advise patient to come immediately to hospital if develop signs and symptoms of PE.

3. Urinary Dipstick to screen new onset of proteinuria.

4. CTG and ultrasound to monitor fetal well being.

5. Re assurance to the patient.

6. Can allow to deliver SVD unless there is indication for C-Sec.