COMMENTARY

Primary Care Docs Have Role to Play in Hypertension Prevention and Treatment for Women of Reproductive Age

Santina J.G. Wheat, MD

January 27, 2022

The American Heart Association recently released a scientific statement concerning hypertension in pregnancy, which laid out the variety of disorders, the epidemiology, the future impact of pregnant persons, and the current debates regarding treatment and diagnosis.

This statement addresses all stages from preconception through post pregnancy and outlines the many prevention and treatment options available. Although family physicians were not specifically called out to be partners in the statement, we have a large role to play for both our pregnant patients and those of reproductive age who are not pregnant.

Preconception Health

One of the first things pointed out was preconception health. Regardless of whether each individual family physician provides prenatal care, we can all focus on preconception health for those of reproductive age.

The statement from the AHA points out that "lifestyle changes before and during pregnancy may ameliorate both maternal and fetal risks."

As many already do, family physicians should focus on encouraging their patients to practice healthy eating and exercise prior to pregnancy to help establish routines that will decrease the risk of hypertensive disorders in pregnancy.

Focusing on care prior to pregnancy also allows the primary care provider to be involved in quickly linking patients to prenatal care, as it is well established that early and complete prenatal care is important for improving outcomes.

Later-in-life Pregnancy

The AHA also highlights that many are choosing to have pregnancies at older ages and with greater comorbidities than in past years. This is another area in which family physicians can provide important care.

We can help by first identifying the chronic conditions, such as hypertension and diabetes, that make the hypertensive disorders of pregnancy more likely. We should then focus on the treatment of these conditions during the preconception time so that they are well controlled prior to pregnancy.

We should also preferentially choose medications that our patients will be able to continue in pregnancy, so that control may be maintained throughout pregnancy.

The statement particularly highlights the avoidance of antihypertensives that are renin-angiotensin system blockers.

We can also help prepare our patients for the additional medications, testing, and precautions they will likely require during their pregnancy so that they know what to expect.

Family physicians are also already starting to utilize home blood pressure monitoring and can introduce this method so that patients may continue to monitor their blood pressures during pregnancy.

Throughout pregnancy, the new statement calls in the current debates of when prenatal care providers should be diagnosing hypertensive disorders and the goals of treatment.

Prenatal care providers can use shared decision-making for medication choices and blood pressure goals. They can also continue to encourage the healthy lifestyle choices such as diet and exercise to reduce the risk of poor outcomes.

This AHA also indicates that prenatal care providers can integrate the use of home blood pressure monitoring as they monitor the blood pressure for patients with hypertensive disorders of pregnancy.

Postpartum Care

The postpartum period is another crucial time for family physicians and other primary care providers to greatly impact their patients with hypertensive diseases of pregnancy.

They can work to ensure that blood pressure is closely monitored and controlled, including by prescribing diuretics, which are typically not used during pregnancy.

If a patient's blood pressure does not go down on its own, the primary care provider can begin treatment for hypertension outside of pregnancy. This can decrease their long-term cardiac risk factors and provide control prior to any future potential pregnancies.

Providing care during this postpartum time also offers a great opportunity to again encourage lifestyle options that may decrease risk.

Family physicians and other primary care providers can also encourage their patient to be involved in registries that gather data on hypertensive disorders in pregnancy.

In the new statement, the AHA acknowledges the great number of things that are not yet known or fully understood and the health inequities that many face.

Family physicians are positioned to help advocate for their patients and utilize a team-based approach to help provide resources to patients. We must continue to be there for our patients at every stage of their lives to help them live their healthiest lives possible.

The statement also indicates that there may be genetic factors at play more than social determinants of health. It is important to identify what those are for the best care of our patients while ensuring we are doing our best to provide our patients with the resources they need.

Wheat is a family physician at Erie Family Health Center and program director of Northwestern University's McGaw Family Medicine residency program, both in Chicago. Wheat serves on the editorial advisory board of Family Practice News. You can contact her at fpnews@mdedge.com.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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