Modern aspects to the management of pregnant women with chronic hypertension

Women with chronic hypertension (CH) are at risk of various adverse fetal/neonatal outcomes, some of which can be mitigated by appropriate pregnancy management. The risk of complications in women with CH increases with hypertension severity and organ damage. With an increase in the relative risk of these complications, the absolute risk of serious damage to target organs (heart, kidneys, brain) remains low in the absence of preeclampsia or uncontrolled hypertension. Careful monitoring of blood pressure, including the use of home monitoring of the pregnant woman herself, allows minimizing the use of medications, especially in the first trimester, according to physiological changes in blood pressure in the second and third trimesters of pregnancy and the start of antihypertensive drugs ≥140/90 mmHg.

There is no doubt that antihypertensive therapy has benefits for women with CH. However, it should be remembered that the long-term goals for treating hypertension in adults fundamentally differ from those for treating hypertension in the short term. The general principle is to gradually reduce blood pressure to avoid a significant decrease in blood flow in the uteroplacental bloodstream. The choice of an antihypertensive drug depends on the safety of the drug, the degree of increase in blood pressure, the availability of drugs, the doctor's experience, as well as side effects and contraindications. The key to managing women with CH is pre-pregnancy counseling about pregnancy risks and possible interventions to minimize these risks.

This review systematizes national and international approaches for the management of pregnant women with CH using evidence-based medicine. Modern recommendations should become the basis for personalized management and treatment of pregnant women with CH.