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Health - Severe Hypertension

Hypertension in Pregnant Women

Sunday, Jan 22 2012

  

Hypertension in pregnancy involves a significant risk to both mother and baby. Although the incidence of eclampsia is falling, hypertension in pregnancy still results in some maternal deaths, and can cause miscarriages, preterm deliveries, and small for date babies due to placental problems. Mothers can be left with chronic hypertension and increased lifelong cardiovascular risk.

    Chronic hypertension affects 1 to 5% of pregnancies.
  Pregnancy-induced hypertension (now preferably known as gestational hypertension) affects 5 to 10% of all pregnancies. It is more common in first pregnancies (up to 25%).

Hypertension in pregnancy includes:

  Gestational hypertension - pregnancy-induced hypertension which develops after 20 weeks’ gestation and may be either transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy.
      Pre-eclampsia: pregnancy-induced hypertension in association with proteinuria and/or oedema or both.
      Eclampsia - occurrence of one or more convulsions superimposed on pre-eclampsia.

Gender has an important influence on blood pressure, with premenopausal women having a lower arterial blood pressure than age-matched men. Compared with premenopausal women, postmenopausal women have higher blood pressures, suggesting that ovarian hormones may modulate blood pressure. However, whether sex hormones are responsible for the observed gender-associated differences in arterial blood pressure and whether ovarian hormones account for differences in blood pressure in premenopausal versus postmenopausal women remains unclear. In this review, we provide a discussion of the potential blood pressure regulating effects of female and male sex hormones, as well as the cellular, biochemical and molecular mechanisms by which sex hormones may modify the effects of hypertension on the cardiovascular system.

High blood pressure, or hypertension, is a risk factor for a number of conditions, including heart disease and stroke. It is defined as a systolic blood pressure (during heartbeats) of 140 mmHg or higher, a diastolic blood pressure (between heartbeats) of 90 mmHg or higher, or current use of blood pressure-lowering medication. In 200 - 2008, about 30 percent of both women and men were identified as having high blood pressure. This includes about 14 percent of adults with controlled hypertension, who had a normal blood pressure measurement and reported using blood pressure-lowering medication, and about 16 percent with uncontrolled hypertension, who had a high blood pressure measurement with or without the use of medication. High blood pressure can also be controlled by losing excess body weight, participating in regular physical activity, and adopting a healthy diet with lower sodium intake.

The prevalence of hypertension varies by race and ethnicity. For example, 39.4 percent of non-Hispanic Black women had high blood pressure compared to 16.3 percent of Mexican American women.

Among women with uncontrolled high blood pressure in 2005 -2008, 54.4 percent had been previously diagnosed by a health professional and were taking medication for the condition; 11.9 percent had been previously diagnosed but were not taking medication; and 33.7 percent had never been diagnosed. Diagnosis status among women with uncontrolled high blood pressure varied by age as well as race and ethnicity. Younger women aged 18 - 44 were most likely to be undiagnosed (41.0 percent), while older women aged 65 and over were most likely to be diagnosed and taking medication (64.0 percent). With respect to race and ethnicity, Mexican American women with uncontrolled high blood pressure were most likely to be undiagnosed (45.6 percent), while non-Hispanic Black women were most likely to have been diagnosed and taking medication (61.3 percent).

Preeclampsia, which is also sometimes called toxemia, is a disorder that only occurs during pregnancy and can also occur during the period right after delivery. It can greatly affect both the mother and unborn baby. Preeclampsia occurs in about 5 to 8 percent of all pregnancies, and very severe cases of preeclampsia can be life threatening. Typically, this condition develops after the twentieth week of pregnancy, in the late second trimester and into the third trimester, although for some it can develop earlier. High blood pressure that develops before the twentieth week is usually a sign of chronic high blood pressure or pregnancy-induced hypertension, but it can also be an early sign of preeclampsia.

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Untreated, preeclampsia can cause high blood pressure, problems with blood supply to the placenta and fetus, problems to the liver, kidney, and brain function of the mother as well as the risk of stroke, seizures, and fluid on the lungs. Because the condition affects the blood flow to the placenta and fetus, the baby has a harder time getting the oxygen and nourishment it needs. These babies are often smaller in size and tend to be born prematurely. Women who develop severe preeclampsia can develop life-threatening seizures called eclampsia.

Both chronic high blood pressure and preeclampsia can develop gradually or suddenly and can be mild or severe. If you develop high blood pressure during your pregnancy, you will be monitored closely for signs of preeclampsia throughout your pregnancy.

Diagnosing

There is no single test that can diagnose preeclampsia. Your blood pressure is checked at each and every doctor’s visit, which makes regular prenatal care even more essential for all pregnant women. A sudden rise in your blood pressure can be an early sign of preeclampsia. A urine test is also used to check for protein in the urine, which can be another warning sign.

Signs and Symptoms

The signs and symptoms of pregnancy-induced hypertension and pre-eclampsia can be classified into three categories: mild, moderate, and severe. The signs and symptoms of high blood pressure and preeclampsia are often silent if the condition is mild. Suspicions usually surface unexpectedly during routine blood pressure checks and urine tests. Moderate preeclampsia can bring with it signs of high blood pressure, protein in the urine, rapid weight gain (more than 1 pound a day), problems with blood clotting, and excessive swelling of the hands and face. Severe preeclampsia can show signs of brain or certain body organ trouble, such as severe headaches, dizziness, vision problems, breathing problems, abdominal pain, and decreased urination. Very rarely, preeclampsia can progress to a condition called eclampsia that can be life-threatening, especially if the preeclampsia is not treated properly and early enough.

Signs of edema or swelling alone do not necessarily mean that you have preeclampsia. Edema can be a very normal symptom of pregnancy. It is considered more serious when it does not go away after putting your feet up, if it is very obvious in your face and hands, and if it causes a rapid weight gain of more than 5 pounds per week or more than 1 pound per day.
Treatment

If you are diagnosed with preeclampsia, treatment depends on the severity of your condition, the health of your baby, and the stage of your pregnancy. It is recommend that you lie on your left side as much as possible to help take unnecessary pressure off the blood vessels. This allows for greater blood flow.

If you develop mild preeclampsia close to your due date, and your cervix is showing signs of thinning and dilation, your doctor may want to induce labor. This will help prevent any complications that could develop if the pre-eclampsia were to worsen before your delivery.

If your cervix is not showing signs that it is ready for induction, your doctor will probably monitor you and your baby very closely until the time is right to induce or until labor begins on its own. If you develop preeclampsia before the thirty-seventh week of pregnancy, your doctor will most likely recommend bed rest, either at home or in the hospital, depending on your situation. For some, depending on the severity of the blood pressure, blood pressure medication will be prescribed until the pressure stabilizes or until delivery. With severe preeclampsia, a medication to prevent eclampsia (a very serious condition involving seizures) may also be prescribed.

Even though cutting salt from your diet is usually a good way to help control high blood pressure, it is not a good idea to cut the salt in your diet if you have high blood pressure during pregnancy. It is essential that your body gets a normal intake of salt during pregnancy. If you have questions about salt intake with regard to your blood pressure, ask your doctor and a registered dietitian for advice and information.

In general, if you develop preeclampsia, delivery of your baby is the best way to protect you both from complications. If this isn’t possible because it is too early in the pregnancy, steps will be taken to manage the preeclampsia until your baby can be safely delivered and survive outside of the womb.

At this point, early diagnosis through simple blood pressure checks and other routine tests at regular prenatal visits is the best way to detect pregnancy-induced hypertension or preeclampsia. The earlier the condition is detected, the earlier treatment and monitoring can begin and the better chance you and your baby have for a healthy pregnancy and healthy delivery.

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Pregnancy complicated by chronic hypertension

Chronic hypertension is high blood pressure, usually greater than 140/90. High blood pressure is famous for banging up blood vessels and the organs supplied by them. The hypertensive patient, feeling fine for years, may ultimately see this damage as strokes in the brain, heart disease and heart attacks in the heart, and kidney damage.

Strokes and heart attacks are serious enough, but damage to the kidney could further encourage more hypertension because the kidneys play an important role in managing normal blood pressure in healthy people.

Substances called angiotensins are part of a cascade of chemistry in the kidneys, and they are important in raising blood pressure, ordinarily to maintain normal levels in healthy conditions. So it is not surprising that one of the newer drug types to treat hypertension is a medicine that blocks the chemical reactions that the angiotensins take part in. They are called ACE inhibitors (“Angiotensin-1 Converting Enzyme” inhibitors), and they include catopril, micardis, and the brand name Vasotec (enatapril).

But these popular medications are suspected of causing deformities to babies, specifically if given in the later trimesters, so pregnant patients with high blood pressure are left with the older treatments. Fortunately, there are a lot of them, and they still all work pretty well.

For example, Lopressor (metoprolol) and labetalol act by blocking the nerves that constrict the muscles in arteries and strengthen the heart’s contraction efforts (= lower blood pressure). Aldomet (methyldopa) works in a similar way, but is less selective in the particular nerve effects, meaning there may be more side effects.

Untreated, hypertension can also affect the baby as well as the mother. The same damaging effects to the blood vessels in the expectant mother can also damage the blood supply involved with placental exchange of oxygen and nutrition from mother to baby. This can age the placenta prematurely, and the famous result in hypertensive pregnancies is intrauterine growth restriction (IUGR - small babies) and oligohydramnios (low amount of amniotic fluid). Ironically, hypertension in the mother so blocks the normal nutritional exchange that the fetus has the opposite problem - hypotension (low blood pressure) - which can endanger the fetal kidneys, decreasing the amount of urine the unborn baby produces (the urine being the most significant portion of amniotic fluid).

ACE inhibitors will exaggerate this danger considerably, so it is recommended that ACE inhibitors be discontinued as soon as pregnancy is diagnosed. One relief to the newly pregnant patients who have been on ACE inhibitors is that the danger seems to be in the later point of pregnancy, so getting off of them in early pregnancy is probably all that need be done to relieve any worries.

(The American College of Obstetricians and Gynecologists states, “With the exception of the ACE inhibitors, there is no need to discontinue any of the other drugs commonly used to treat hypertension in a pregnant patient whose blood pressure is well controlled.”)

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The life of a woman is hectic and it’s all about balancing this, that and the other. Be it urban or rural, she has a plethora of things to take care of. In cities and metros, she juggles between the household and her work. In villages she has to do a lot of manual labour, work in the fields and also take care of her household. All this makes her an easy target of Hypertension. Women hardly have the time and energy to see what they are eating and what is good for their health.

High Blood pressure, which is directly responsible for 57% of deaths due to stroke and 24% of fatalities caused by heart attack, has been found to be rampant in the case of Indian urban women. A study conducted over three years, spearheaded by the All India Institute of Medical Sciences (AIIMS), highlighted that almost one in two women in urban India suffer from hypertension.

The case is not very different in rural India. One in three women in rural sites are also said to be suffering.

What makes this worse is the fact that only one in five hypertensive women were on treatment, and less than 4% are controlled. The study, involving 4,608 - rural 2,604 and urban 2,004 - women in Delhi, Haryana, Jaipur, Pune, Kolkata, Kochi and Gandhigram, also showed that awareness about the status of their blood pressure was very low with only half of urban and a quarter of rural hypertensive patients being aware of their condition.

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Team MSN She


Provided by Armina Hypertension Association

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