Cardiac Consult: A Cleveland Clinic Podcast for Healthcare Professionals Management of Hypertension in Pregnancy and Postpartum
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May 2, 2024 Dr. Deirdre Mattina, a cardiologist specializing in maternal cardiovascular health, discusses the complexities of managing hypertension during and after pregnancy. She defines hypertensive disorders and explains the differences between chronic and gestational hypertension. Dr. Mattina emphasizes the importance of preconception counseling and reviews preferred antihypertensive medications. She also delves into the long-term cardiovascular risks associated with preeclampsia and highlights the benefits of a Mediterranean diet. Additionally, she addresses postpartum care challenges and best practices.
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Hypertension Is Common And Risky In Pregnancy
- Hypertensive disorders affect 5–10% of pregnancies and increase long-term cardiovascular risk for women.
- Severe sustained hypertension is systolic ≥160 or diastolic ≥110 for at least 15 minutes and needs urgent management.
Preconception Counseling And Medication Switch
- Do preconception counseling for women with chronic hypertension to screen for end-organ damage and secondary causes.
- Switch teratogenic meds before conception and use pregnancy-safe agents like labetalol or nifedipine.
Medication Choices For Pregnant Patients
- Use labetalol and nifedipine as first-line antihypertensives in pregnancy and consider hydralazine or diuretics as adjuncts.
- Avoid ACE inhibitors, ARBs, MRAs, and ARNIs during pregnancy; use IV labetalol, IV hydralazine, or short-acting nifedipine for severe acute hypertension.