Treatment of arterial hypertension in pregnancy in relation to current guidelines of the Polish Society of Arterial Hypertension from 2011

Abstract

Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity, resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines. Different opinions in the subject of terminology and classification of pregnancy hypertension or indications for pharmacotherapy, as well as choice of the optimal antihypertensive drug, emerge from objective causes such as combination of various pathogenetic factors typical for arterial hypertension itself and those connected with pregnancy, elsewhere stressed priorities of therapy from the point of view of the health of the mother and of the fetus, as well as lack of randomized clinical trials due to obvious ethical purposes, but also from the fact that pregnancy hypertension is a focus of attention for different specialists – obstetricians, hypertensiologists and perinatologists. A good cooperation regarding experience and information among all of these specializations would be the most beneficial for pregnant women and their children. Lack of new modern antihypertensive agents, safe and effective in pregnancy, while the older ones are being withdrawn from the market as their production is no longer cost-effective for pharmacological companies, has become an increasing problem in many countries, and Poland among them. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the Polish Society of Arterial Hypertension 2011 to gynecologists and obstetricians, with a commentary. According to the guidelines, methyldopa, labetalol (or metoprolol), long-acting nifedipine or verapamil should be used in the therapy of mild and moderate pregnancy hypertension, preferably in the given order. In case of severe and life-threatening arterial hypertension, labetalol intravenously should be administered and if it is still not sufficient, eventually sodium nitroprusside or hydralazine could be ordered, bearing in mind their possible adverse effects. Unfortunately, labetalol, nifedipine, hydralazine and sodium nitroprusside are no longer available in Poland, which significantly narrows the practical treatment possibilities in the pregnant population. Inhibitors of angiotensin converting enzyme and angiotensin II receptor blockers are contraindicated during pregnancy and breastfeeding, as well as aldosteron inhibitors, as suggest in the guidelines. In the paper the authors present the guidelines and also, based on the information available to date in medical journals, other hypertension pharmacotherapeutic options possible for consideration in pregnancy, which could be helpful in management of severe arterial hypertension in pregnancy.