What’s a dan­ger­ous level of blood pres­sure in preg­nancy?

The Borneo Post - Nature and health - - Vital Signs -

HIGH blood pres­sure rates could nearly dou­ble in women of child­bear­ing age if the lat­est guide­lines are used, ac­cord­ing to a new study. But re­searchers say more in­ves­ti­ga­tion is needed to see if those lower blood pres­sure tar­gets in preg­nant women are safe – or ef­fec­tive. The study, pub­lished in the jour­nal Hy­per­ten­sion, set out to see how re­pro­duc­tive-age women would be im­pacted by the blood pres­sure guide­lines re­leased last Novem­ber from the Amer­i­can Heart As­so­ci­a­tion and the Amer­i­can Col­lege of Car­di­ol­ogy.

Those guide­lines low­ered the thresh­old for high blood pres­sure in adults to 130/80. Guide­lines for preg­nant women set by the Amer­i­can Col­lege of Ob­ste­tri­cians and Gy­nae­col­o­gists de­fine high blood pres­sure as 140/90. The AHA/ACC guide­lines ap­ply to all adults and don’t specif­i­cally ad­dress blood pres­sure tar­gets dur­ing preg­nancy. It notes that hy­per­ten­sion in preg­nancy has spe­cial re­quire­ments and pro­vides rec­om­men­da­tions on types of an­ti­hy­per­ten­sive med­i­ca­tions to use or to avoid dur­ing preg­nancy.

Al­though the scope of the AHA/ACC guide­lines doesn’t ad­dress preg­nancy in de­tail, it de­fers to the ACOG guide­lines as a source for how to man­age high blood pres­sure in preg­nant women. Re­searchers from Emory Univer­sity School of Medicine in At­lanta an­a­lysed data from women ages 20 to 44 and found an al­most twofold jump in the num­ber of women con­sid­ered to have high blood pres­sure. The num­ber rose from 10.2 per cent un­der the ACOG guide­lines to 18.9 per cent un­der the AHA/ACC guide­lines.

“Based on new guide­lines, about twice as many women of re­pro­duc­tive age will carry a di­ag­no­sis of hy­per­ten­sion,” said the study’s lead au­thor, Dr Matthew Topel, a car­di­ol­ogy re­search fel­low at Emory. “It may be rea­son­able to con­sider low­er­ing the blood pres­sure thresh­old for hy­per­ten­sive dis­or­ders of preg­nancy to 130/80, but fur­ther in­ves­ti­ga­tion into this is­sue is needed.” Topel said young women usu­ally have a low risk for ad­verse ef­fects of high blood pres­sure. But among women who be­come preg­nant, hy­per­ten­sion is as­so­ci­ated with risks for both the mother and child, in­clud­ing still­birth, fe­tal growth re­stric­tion and preeclamp­sia.

Preeclamp­sia is a se­ri­ous con­di­tion usu­ally char­ac­terised by high blood pres­sure and el­e­vated pro­tein in the urine. It can en­dan­ger the lives of both the child and the mother. Women with high blood pres­sure dur­ing preg­nancy are also five times more likely to have a stroke than those with nor­mal blood pres­sure. Dr Alisse Haus­purg, an ob­ste­tri­cian and re­searcher who was not in­volved in the new study, said the re­sults could, in the­ory, have sig­nif­i­cant im­pli­ca­tions for how doc­tors and preg­nant women man­age high blood pres­sure.

Ob­ste­tri­cians gen­er­ally don’t rec­om­mend ma­jor life­style changes for preg­nant women with high blood pres­sure, as they might for non-preg­nant women with hy­per­ten­sion, said Haus­purg, a ma­ter­nal-fe­tal medicine fel­low at the Univer­sity of Pitts­burgh Med­i­cal Cen­ter. In­stead, they fo­cus on in­creased ma­ter­nal and fe­tal mon­i­tor­ing, in­clud­ing growth ul­tra­sounds and fe­tal heart mon­i­tor­ing. The study ul­ti­mately said it is un­clear whether lower blood pres­sure tar­gets will ac­tu­ally ben­e­fit preg­nant women.

“It’s not as straight­for­ward as it is in the non-preg­nant pop­u­la­tion,” Haus­purg said. “In preg­nancy, blood flow to the uterus and pla­centa are also im­por­tant to en­sure ad­e­quate fe­tal growth. If we lower women’s blood pres­sure out­side of preg­nancy, we know it re­duces the risk of stroke and heart dis­ease, but there may be neg­a­tive ef­fects on preg­nancy or growth of the baby. We just don’t know the an­swer to that yet.”

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