Definition
As the word itself anticipates, gestational hypertension consists of an increase in arterial pressure that occurs during pregnancy; in general, the increase in blood pressure begins after the 20th week of gestation and disappears after delivery.
- In the first months of pregnancy there is an opposite event (physiological reduction of blood pressure)
Causes
A single cause implicated in the manifestation of gravidic hypertension has not yet been identified with certainty; however, the association of several factors could heavily affect the onset of the disorder: a low-calorie diet low in calcium, zinc and proteins, changes in the immune system, genetic predisposition, and placental malfunction.
- Risk factors: age below 20 or over 35, multiple pregnancies, first pregnancy, genetic predisposition
Symptoms
The symptoms that accompany gestational hypertension can be realized in: decrease in the amount of urine, abdominal pain, swelling of the face and ankles, severe headache, systolic pressure increase greater than 25-30 mmHg (compared to conception), increase diastolic blood pressure greater than 15 mmHg (compared to conception), urinary loss of protein (preeclampsia), arterial pressure above 140 / 90mmHg, fatigue, vomiting.
Information on Hypertension in Pregnancy - Drugs for the Management of Gestational Hypertension is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hypertension during pregnancy - Drugs for the treatment of gestational hypertension.
drugs
Arterial hypertension constitutes a rather dangerous condition, since it can cause serious consequences to the unborn child, such as growth block and neonatal mortality; therefore, monitoring of pressure values and urinalysis are two essential preventive strategies during pregnancy.
Before embarking on a therapeutic-pharmacological path, it is essential to take into account some very distinct elements:
- Possibility of fetal risks
- Need to decrease the pregnant woman's blood pressure
- Distinguish chronic hypertension (already present at conception) from gestational hypertension (occurred after the 20th week)
In the event of a confirmed diagnosis of gestational hypertension, bed rest is useful to reduce peripheral vasoconstriction and improve uterus-placental flow.
It is recommended to start therapy for the treatment of gestational hypertension when the minimum pressure values (diastolic) exceed 100-105 mmHg; in order to avoid eclampsia, it is recommended to lower the pressure if the values exceed 170/110 mmHg.
If the diastolic pressure was between 90 and 99 mmHg, behavioral therapy is generally sufficient to bring blood pressure to normal:
- reduce body weight if necessary
- avoid taking foods rich in sodium
- avoid excessive efforts
- do not drink alcohol
- not smoking
- drink a lot of water
- Alpha-Methyldopa (eg Aldomet): centrally acting antihypertensive, used during pregnancy because it is safe. It is recommended to start therapy with a dose of 250 mg, to be taken orally 2-3 times a day; alternatively, it is possible to take 250-500 mg for a slow infusion of 30-60 minutes every 6 hours. Do not exceed 3 grams per day. The maintenance dose involves taking 500 mg of active (max. 2 g), divided into 2-4 doses, up to a maximum of 3 grams per day. The drug can also be used to treat hypertensive crises during gestation: in this case, it is recommended to take 250-500 mg of active, for a slow infusion of 30-60 minutes, every 6 hours, as long as the blood pressure returns to physiological values.
- Nifedipine (eg. Adalat): the active ingredient (calcium antagonist) is generally available in slow-release tablets: however, it is a second-choice drug for the treatment of gestational hypertension. As an indication, start the drug with an oral dose of 30-60 mg. The dosage can be changed every 7-14 days.
- Labetalol (eg Ipolab, Trandate, Trandiur): indicated for the control of hypertensive crises. The drug is usually given intravenously, even if it is sometimes taken orally. For the treatment of hypertensive crises during pregnancy, it is recommended to take the drug at a dose of 20 mg by intravenous injection (2 minutes); after 10 minutes it is possible to administer the drug again by IV injection (40-80 mg dose). Do not exceed 300 mg of active. In general, the maximum therapeutic effect occurs 5 minutes after administration. Or take 100 mg of drug twice a day; follow the therapy with a dose of 200-400 mg of drug, twice a day.
- Hydralazine (eg Presfillina): this antihypertensive drug, like the previous one, should be administered intravenously and is indicated for controlling hypertensive crises. In similar situations, it is recommended to take 20-40 mg of active intravenously or intramuscularly, as needed. Consult your doctor. Currently, the drug is not produced or marketed in Italy.
- Clonidine (eg Catapresan, Isoglaucon): the drug is an agonist of imidazoline receptors, indicated both for the treatment of chronic hypertension, and for the gestational form. Indicatively, start therapy with ½ or 1 tablet of 150 mcg. The dosage must be perfected by the doctor.
- Magnesium sulphate (eg. Magne So BIN, Magne So GSE): represents the drug useful in the prevention of eclampsia, in which gestational hypertension is a characteristic symptom. The dosage must be established by the doctor.
The administration of beta blockers for the reduction of blood pressure during gestation is possible only starting from the third month.
Women with chronic hypertension, even before pregnancy, should pay particular attention to the administration of diuretics, sartans and ACE inhibitors, given the possible complications derived from the administration of these drugs, both for the mother and the unborn child.
