High blood pressure treatment in pregnancy appears safe, prevents
maternal heart risks

Date:
December 15, 2021
Source:
American Heart Association
Summary:
High blood pressure during pregnancy remains a major cause of
maternal and fetal pregnancy-related complications and death, and
it increases women's short- and long-term risks for cardiovascular
disease. Emerging data from clinical trials and observational
research support the benefits and safety of blood pressure treatment
during pregnancy. Continued investigation is critical to determine
which blood pressure levels, during- and post-pregnancy, both for
starting therapy and as treatment goals, are beneficial for the
mother and safe and beneficial for the fetus.



FULL STORY ========================================================================== Treatment for high blood pressure during pregnancy appears safe for
many women and may reduce maternal risk for severe hypertension without increasing fetal and neonatal risks, according to a new American Heart Association scientific statement published today in the Association's
journal Hypertension.


==========================================================================
A scientific statement is an expert analysis of current research and
may inform future clinical practice guidelines. In this statement, "Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy," experts in obstetrics and gynecology, maternal-fetal medicine, cardiology, nephrology, hypertension and internal medicine
reviewed and analyzed quality studies focusing on high blood
pressure during pregnancy including gestational hypertension and preeclampsia/eclampsia.

The latest American Heart Association statistics indicate hypertension
during pregnancy, defined as a systolic pressure (the top number in a
blood pressure reading) of 140 mm Hg or higher, is the second leading
cause of maternal death worldwide. Severe cases are associated with
increased risks of cardiovascular complications for mothers immediately
or soon after delivery, and for years after pregnancy. Hypertension during pregnancy increased the risks for complications for the offspring such as preterm delivery, small for gestational age and low birthweight. Rates
of hypertension during pregnancy are increasing globally, and the data
indicate that it disproportionately affects women who are from diverse
racial and ethnic backgrounds in the U.S., particularly those who are
Black, American Indian or Alaskan Native.

The goals of treatment during pregnancy include preventing severe
hypertension and preventing early delivery to allow the fetus time to
mature before delivery.

"For decades, the benefits of blood pressure treatment for pregnant
women were unclear. And there were concerns about fetal well-being from exposure to antihypertensive medications," said Chair of the statement
writing group Vesna D. Garovic, M.D., Ph.D., a professor of medicine,
chair of the division of nephrology and hypertension with a joint
appointment in the department of obstetrics and gynecology at Mayo
Clinic in Rochester, Minnesota. "Through our comprehensive review of
the existing literature, it is reassuring to see emerging evidence that treating high blood pressure during pregnancy is safe and effective
and may be beneficial at lower thresholds than previously thought. Now,
we have the current statement focused on hypertension during pregnancy
to help inform optimal treatment and future research." According to
the statement, among high-income countries, the United States has one
of the highest hypertensive-related maternal mortality rates.

Cardiovascular disease, which includes stroke and heart failure,
now accounts for up to half of all maternal deaths in the U. S, and pregnancy-related stroke hospitalizations increased more than 60%
from 1994 to 2011. Preeclampsia, which occurs when hypertension during pregnancy is accompanied by signs of liver or kidney problems such as
protein in the urine, affects 5% to 7% of pregnancies and is responsible
for more than 70,000 maternal deaths and 500,000 fetal deaths worldwide
every year, according to the American Heart Association.



========================================================================== "Given the rising number of cases of hypertension during pregnancy,
together with hypertension-related complications, the problem has
become a public health crisis, particularly among women from racially
and ethnically diverse backgrounds," Garovic said.

While the definition of hypertension for the general population is
established at 130/80 mm Hg according to the 2017 in the American College
of Cardiology (ACC)/ American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure
in Adults, most guidelines worldwide define hypertension during pregnancy
as 140/90 mm Hg.

There is a lack of consensus about when to start hypertension treatment
during pregnancy because of concerns about how medications may impact
the fetus.

Several health advocacy groups recommend beginning treatment when blood pressure measures during pregnancy are from 140/90 mm Hg (Canadian
guidelines) to 160/110 mm Hg (U.S. guidelines).

The new statement points to evidence that blood pressure-lowering
therapy for pregnancy hypertension significantly reduces the incidence
of severe hypertension. Additional research is needed to determine the
extent to which treating hypertension at a lower threshold may decrease
serious hypertensive complications, namely organ damage and hypertensive emergencies. Reducing severe hypertension may be particularly important in communities that lack resources and expertise to respond to hypertension emergencies, the statement authors write.

"Future studies should address whether lowering the threshold for treating hypertension during pregnancy might allow for safe and timely blood
pressure control and avoid a rushed delivery because of uncontrolled hypertension," said Garovic.

So far, the latest research indicates that treating hypertension
during pregnancy with blood pressure-lowering medicine does not
appear to negatively impact fetal growth or development. Preventing hypertension during pregnancy supports maternal health both during
and after pregnancy. It is well known that those who have hypertension
during pregnancy are more likely to develop sustained hypertension after pregnancy at a higher rate compared to those whose blood pressure was
normal during pregnancy. The statement reinforces recent research that
suggests lifestyle changes before and during pregnancy have the potential
to improve maternal and fetal outcomes:
* Dietary changes before and during pregnancy can limit weight
gain and
improve pregnancy outcomes.

* Exercise during pregnancy may reduce gestational hypertension
risk by
about 30% and preeclampsia risk by about 40%.

The statement also highlights these areas of concern:
* There is emerging evidence that hypertension after delivery
(postpartum)
may be associated with significant maternal health problems.

* The current science suggests physicians should individualize
treatment
decisions, considering risk factors and patient preferences.

* The care of women with hypertension during pregnancy is often
complex,
and a multispecialty team of health care professionals may be
beneficial.

"Future clinical trials are needed to address questions about
when to begin treatment for high blood pressure during pregnancy,"
Garovic said. "Also, close collaboration between the American Heart
Association and American College of Obstetricians and Gynecologists
will be instrumental in optimizing diagnosis and treatment of
hypertension during pregnancy and in improving immediate and long-term
outcomes for many women who develop hypertension during pregnancy." ========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Vesna D. Garovic, Ralf Dechend, Thomas Easterling, S. Ananth
Karumanchi,
Suzanne McMurtry Baird, Laura A. Magee, Sarosh Rana, Jane
V. Vermunt, Phyllis August. Hypertension in Pregnancy: Diagnosis,
Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement
From the American Heart Association. Hypertension, 2021; DOI:
10.1161/HYP.0000000000000208 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211215082035.htm

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