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Chronic Medical Conditions:  Hypertension - Case Information                         

Page 7 of 15    

 

Would you know how to counsel Miss Grainger regarding her hypertension with respect to her future potential pregnancy?

 

Patient:  Miss Grainger 

 

Miss Grainger's History & Medications

 

Make sure that you have counseled Miss Grainger on her diagnosis of HTN and have informed her of the risks it poses on her future pregnancies:

  • preeclampsia
  • premature birth
  • intrauterine growth restriction (IUGR)
  • fetal demise
  • placental abruption
  • cesarean delivery
  • small for gestational age infants
  • significantly increased perinatal morbidity and mortality
    •

    Depending on the severity of her HTN, you may or may not think it’s indicated to establish baseline levels for end-organ damage – retinae, heart, kidneys.

     

     

    Things to Consider:

     

    Whether or not to treat patients’ mild to moderate (Stage I) chronic HTN throughout the pregnancy is debatable according to the literature as there is no clear improvement in perinatal outcome. Treatment of severe chronic HTN is recommended as it is associated with improved perinatal outcome. While there are risks associated with medications, there is also the risk of maternal disease progression during pregnancy.

     

    That said, you will definitely want to take her off of lisinopril (ACE inhibitor); ACE inhibitors and ARBs are not safe for pregnancy due to fetal effects in the second trimester as well as newer information regarding potential teratogenicity in the first trimester. Diuretics are not typically recommended in pregnancy due to the potential for limiting the normal volume expansion that occurs in pregnancy although there are no teratogenic effects; so you would want to consider discontinuing the HCTZ (diuretic).

     

    If you do choose to medicate Miss Grainger throughout her pregnancy (should she conceive), aldomet has a good record of being safe during pregnancy and is used everywhere for this purpose. Other options include calcium channel blockers and beta blockers.