How is severe hypertension managed in preeclampsia?

Updated: Nov 29, 2018
  • Author: Kee-Hak Lim, MD; Chief Editor: Ronald M Ramus, MD  more...
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In the setting of severe hypertension (SBP >160 mm Hg; DBP >110 mm Hg), antihypertensive treatment is recommended. The goal of hypertension treatment is to lower BP to prevent cerebrovascular and cardiac complications while maintaining uteroplacental blood flow (ie, maintain BP around 140/90 mm Hg). However, although antihypertensive treatment decreases the incidence of cerebrovascular problems, it does not alter the progression of preeclampsia. Control of mildly increased BP does not appear to improve perinatal morbidity or mortality, and it may, in fact, reduce birth weight.

A retrospective cohort study by Cleary et al that included 239,454 patients with preeclampsia (126,595 women with mild, 31,628 with superimposed, and 81,231 with severe preeclampsia) reported that the rate of patients with preeclampsia receiving antihypertensive medication increased from 37.8% in 2006 to 49.4% in 2015. During this time period, the risk for stroke for severe preeclampsia also decreased from 13.5 per 10,000 deliveries in 2006-2008 (n=27) to 6.0 in 2012-2014 (n=20) (P=.02). [69]

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