Treating Hypertensive Disorders of Pregnancy Beneficial, Safe: AHA

NEW YORK (Reuters Health) – Emerging data support the benefits and safety of treating hypertensive disorders of pregnancy (HDP), the American Heart Association (AHA) says in a new scientific statement.

HDP remain a major cause of maternal and fetal pregnancy-related complications and death, and they increase women’s short- and long-term risks for developing cardiovascular disease.

“Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population,” the writing group notes in Hypertension.

“The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication,” they add.

Based on their review of the available literature, the writing group concludes that treating HDP may reduce the mother’s risk for severe hypertension without increasing fetal and neonatal problems.

Further, they say reclassifying HDP using the lower American College of Cardiology/AHA diagnostic threshold of 130/80 mm Hg “may better identify women at risk for developing preeclampsia and adverse fetal/neonatal outcomes.”

“Given the rising number of cases of hypertension during pregnancy, together with hypertension-related complications, the problem has become a public health crisis, particularly among women from racially and ethnically diverse backgrounds,” writing group chair Dr. Vesna D. Garovic of Mayo Clinic in Rochester, Minnesota, said in a news release.

“For decades, the benefits of blood pressure treatment for pregnant women were unclear. And there were concerns about fetal well-being from exposure to antihypertensive medications,” she added.

“Through our comprehensive review of the existing literature, it is reassuring to see emerging evidence that treating high blood pressure during pregnancy is safe and effective and may be beneficial at lower thresholds than previously thought. Now, we have the current statement focused on hypertension during pregnancy to help inform optimal treatment and future research,” Dr. Garovic said.

The AHA advises multidisciplinary, team-based personalized care where clinicians partner with the patient to determine the best treatment and consider the risks for hypertension-related adverse outcomes.

Dr. Garovic said close collaboration between the AHA and the American College of Obstetricians and Gynecologists (ACOG) will be “instrumental in optimizing diagnosis and treatment of hypertension during pregnancy and in improving immediate and long-term outcomes for many women who develop hypertension during pregnancy.”

SOURCE: Hypertension, online December 15, 2021

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