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Hypertension in pregnancy
Claudio Borghi, F.E.S.C., F.A.H.A,
Department of Medical and Surgical Sciences
University of Bologna
Bologna, Italy
Hypertension in pregnancy
Epidemiology
• The risk for stroke was twice than controls in subjects born
from pre-eclamptic pregnancies
• Gestational Hypertension
• Chronic Hypertension (of any cause)
• Pre-eclampsia/eclampsia
• Chronic hypertension with superimposed pre-eclampsia
From ACOG. Task Force on HBP in Pregnancy, Obstetri Gynecol 2013; 122(5), 11221131
Classification of the Hypertensive Disorders
of Pregnancy by SOGC
Magee LA et Al. Diagnosis, Evaluation and management of Hypertensive Disorders of Pregnancy. JOCG, 2014
Hypertension in
pregnancy
An “heterogeneous”
hemodynamic and neurohumoral
disease
Frida Khalo, 1939
Defintion of pre-eclampsia
The management of HTN in pregnancy
• Primary (perinatal) outcome=Pregnancy loss or high neonatal care for the first 28 days of life
• Secondary (maternal) outcome=one/more serious maternal complications < 6 weeks
*Endorsed by: ESC Guidelines-2011, ESH-ESC Guidelines -2013, NICE Guidelines-2011, ACOG Guidelines-2013, SOCG
Guidelines-2014, ASH/FDA Guidelines 2008, Sibai BM, Obstet Gynecol 2003 , Podymow T, Hypertension 2008
Effects of nifedipine GITS and methyldopa on LV structure, function and
plasma levels of natriuretic peptides in 37 patients with preeclampsia
Atrial
P<0.01 Natriuretic
LVEF P<0.01
Peptide
LVESV
P<0.05
Brain
P<0.01 Natriuretic
P<0.01 Peptide
LVEDV
From: ClinicalTrials.gov
The management of HTN in pregnancy