Petra Vysočanová, Alena Floriánová, Jindřich Špinar
Hypertension complicates 5-10 % pregnancies and is responsible for substantial maternal, foetal and neonatal morbidity and mortality. The definition of hypertension in pregnancy is not unanimous, the one based on absolute blood pressure (BP) values (systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg) is now preferred. Hypertension in pregnancy is not a single entity and is divided to 4 groups: pre-existing hypertension, gestational hypertension, pre-existing hypertension and superimposed gestational hypertension with proteinuria and unclassifiable hypertension. Non-pharmacological treatment of hypertension should be considered in women with BP of 140-150/90-99 mm Hg. Salt restriction or weight reduction is not recommended. Drug treatment in all pregnant women with BP ≥ 150/95 is recommended. Antihypertensive treatment should be considered at values BP ≥ 140/90 mm Hg in women with gestational hypertension, pre-existing hypertension with the superimposition of gestational hypertension or hypertension with target organ damage. Methyldopa, labetalol, calcium-channel blockers and beta-blockers are drugs of choice. ACE inhibitors and AT1 blockers are contraindicated in pregnancy. For severe and complicated hypertension labetalol i.v. and oral nifedipine might be administered. Drugs of second choice in hypertensive emergencies are nitroprusside i.v. or urapidil. All antihypertensive drugs taken by the nursing mother are excreted into breast milk, but most of them are present at very low concentrations. Hypertension in pregnancy is a marker for future cardiovascular and metabolic diseases.