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Management of hypertension in pregnancy


Perinatal and maternal deaths are increased by hypertension in pregnancy.1 2 This comprises (1) essential hypertension, (2) other varieties of hypertension, (3) pre-eclamptic toxaemia of pregnancy, and (4) toxaemia complicating (1) and (2). The treatment of hypertension in pregnancy varies considerably, particularly in the use of hypotensive drugs. This variation arises partly because the obstetrician has a lower threshold for what constitutes ‘hypertension’ in his patients than has the general physician, partly because pre-eclamptic toxaemia is difficult to distinguish from essential and other hypertension in pregnancy and partly from our ignorance of the aetiology and fundamental lesion in the former. Specific microscopic changes have been found on renal biopsy,3 but these lesions may be present in only a minority of those diagnosed clinically as toxaemia.4 At present therefore treatment can only be directed at lowering the blood pressure.

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