Pregnancy-Induced Hypertension and Preedampsia: A Review of Current Antihypertensive Pharmacologic Treatment Options

Review Article

Austin J Pharmacol Ther. 2013;1(1): 1001.

Pregnancy-Induced Hypertension and Preedampsia: A Review of Current Antihypertensive Pharmacologic Treatment Options

Nicole R. Anderson, Megan Undeberg, Karen MS Bastianelli*

College of Pharmacy, University of Minnesota in Duluth, Minnesota

*Corresponding author: : Karen Bastianelli, College of Pharmacy, University of Minnesota in Duluth, Minnesota, 221 Life Science, 1110 Kirby Dr., Duluth, MN 55812

Received: December 06, 2013; Accepted: December 30, 2013; Published: December 31, 2013


Hypertensive emergencies are the second leading cause of maternal mortality during pregnancy, affecting one out of ten pregnancies. Maternal and fetal complications can be devastating and may include stroke, seizures, placental abruption, fetal death, and maternal death. Although prompt recognition and treatment can greatly reduce the morbidity and mortality associated with pregnancy–induced hypertension and preeclampsia, the only known resolution is delivery of the fetus and placenta. Treatment is a balance between managing maternal symptoms to prevent disease progression and prolonging gestation to improve fetal outcomes. Management of pregnancy– induced hypertension and preeclampsia depends on the gestational stage at presentation, severity of disease, and the condition of the woman and fetus. Most common options may include medication therapies and induction of labor. Pharmacologic therapies must be carefully chosen with efficacy and safety for mother and fetus in mind. This literature review explores commonly used medications to manage blood pressure during pregnancy, the current research that supports the safety and efficacy of these agents, and the factors that may play a role in deciding between medication therapy versus induction of labor.

Keywords: Hypertension; Pharmacotherapy; Preeclampsia; Placenta; Angiotensin.


Hypertensive conditions during pregnancy contribute greatly to maternal morbidity and mortality around the world [1]. In the United States, preeclampsia accounts for 15% to 17.6% of maternal deaths [1,2] Hypertension complicates approximately one out of every ten pregnancies [1]. The only resolution for preeclampsia and pregnancyinducedhypertension, also known as gestational hypertension, is delivery of the fetus and placenta [1,3] When hypertensive disorders complicate a pregnancy before full term, the risks of preterm delivery must be considered in addition to the risks to the mother. Often medications are used to manage maternal blood pressure and prolong estation. Although many treatment options exist for hypertension n the general population, additional consideration must be utilized when selecting a pharmacotherapeutic agent in pregnancy. The chosen medication must not only be effective and safe for the mother, but also have minimal impact on the development of the fetus.

The complications of uncontrolled high blood pressure during pregnancy affect multiple organ systems and can be detrimental to both mother and fetus [1,3,4] Maternal complications of preeclampsia include seizure activity, placental abruption, stroke, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), liver hemorrhage, pulmonary edema, acute renal failure, and disseminated intravascular coagulation (DIC). There could be significant morbidity and mortality for the fetus as well. Fetal and neonatal complications include intrauterine growth restriction, preterm birth, low birth weight, neonatal respiratory distress syndrome, increased admission to neonatal intensive care units, and fetal or neonatal death [5].

While the exact causes of preeclampsia are not well understood, certain factors may increase a woman’s risk of developing pregnancyinduced hypertension or preeclampsia. It is widely known that preeclampsia occurs most often during a woman’s first pregnancy [3,5,6,7]. Additionally, women with a history of preeclampsia are more likely to have recurrence in a subsequent pregnancy [3,5,6]. Multiple gestations, such as twins or triplets, increase risk [3,6]. Moreover, certain pre–existing chronic conditions increase a woman’s risk, including diabetes mellitus, gestational diabetes, insulin resistance, chronic hypertension, obesity, chronic kidney disease, lupus, and vascular or connective tissue disorders [1,5,6]. Women over the age of 35 years and women of African American race are considered more at risk for developing preeclampsia [3,7].

While some treatments may lower blood pressure and minimize adverse effects, the only known resolution for pregnancy–induced hypertension and preeclampsia is delivery of the placenta, with signs nd symptoms typically resolving shortly after delivery [3,4] . Prompt recognition of pregnancy–induced hypertension and preeclampsia is vital in preventing progression of the condition. The exact stagingof hypertensive disorders during pregnancy varies slightly between several organizations. These groups maintain their own definitions of staging and diagnostic criteria for blood pressure disorders during pregnancy [1,5,7,8]. Table 1 compares several classification systems used to stage hypertensive disorders during pregnancy.