Hypertension during pregnancy: treatment features

Hypertension is a common companion of women during pregnancy, when metabolic processes in the body intensify and intra-abdominal pressure increases. High blood pressure in pregnant women threatens to develop serious consequences, including premature birth, miscarriage, and even death. Therefore, it is important to have an idea of ​​which antihypertensive drugs are most effective during pregnancy, whether concomitant treatment is necessary, and many other features of hypertension in women during this wonderful and crucial period.

Therapists at the Yusupov Hospital will help you choose a drug for the treatment of hypertension that is both highly effective and has minimal side effects.

Causes of high blood pressure during pregnancy

Arterial hypertension syndrome in women during pregnancy can be triggered by several factors. Blood pressure in pregnant women increases due to the following changes:

• the location of the heart changes;
• hormonal changes occur - the level of progesterone and estrogen in the blood increases;
• placental blood circulation increases;
• body weight increases;
• the mobility of the diaphragm is limited.

The development of all hemodynamic changes during pregnancy leads to a complex of problems that trigger arterial hypertension syndrome.

Symptoms of arterial hypertension

The most common symptoms of high blood pressure are headache, dizziness, fatigue, and nausea. Sleep may also be disturbed, chest pain, palpitations, and shortness of breath often appear.

If you feel unwell, especially if you have previously had arterial hypertension, it is important to measure the pressure in both arms. If the numbers turn out to be different, you need to choose a larger value - this will be the real indicator. With figures of 140/90 mmHg. or higher, you must consult a doctor.

Treatment and hospitalization of pregnant women with hypertension

In order to confirm the diagnosis and select adequate treatment, pregnant women with hypertension syndrome must be hospitalized three times. Antihypertensive drugs during pregnancy are prescribed strictly by the attending physician, who takes into account the duration of pregnancy and possible complications of intrauterine development of the fetus.

• the first hospitalization is carried out in the early stages (up to 12 weeks) - for the purpose of diagnosing hypertension;
• a second hospitalization is planned in the period from 26 to 30 weeks - in order to change therapy;
• The third hospitalization is prescribed a couple of weeks before the birth - to prepare for it.

When gestosis develops against the background of arterial hypertension, the woman requires immediate hospitalization, regardless of how far along the pregnancy she is at that moment.

Arterial hypertension in pregnant women requires constant drug support. Women are prescribed medications, and not only antihypertensives. During pregnancy complicated by high blood pressure, it is recommended to take sedatives, calcium antagonists, beta-blockers, alpha-blockers. In addition, symptomatic therapy is carried out.

In addition to drug therapy, a woman is recommended to follow a special regimen and diet throughout pregnancy.

There are a number of recommendations for pregnant women suffering from arterial hypertension:

• Observing the correct sleep and rest schedule helps to normalize the emotional state - you need to sleep at least 9 hours a day;
• you need to exclude any physical activity;
• A pregnant woman with arterial hypertension syndrome needs to constantly measure her blood pressure.

The nutrition of a pregnant woman, even despite toxicosis, should be complete and nutritious, with a sufficient amount of vitamins, microelements, proteins and antioxidants. It is recommended to include seafood and other foods containing polyunsaturated acids in your diet.

What medications treat arterial hypertension in pregnant women?

Currently, Methyldopa (Dopegit) is considered the safest treatment for hypertension for both mother and baby. This drug reduces blood pressure well, but does not impair the blood supply to the placenta and does not cause developmental abnormalities in the fetus. During pregnancy, when the fetus is 16-20 weeks old, it is recommended to change the treatment regimen by replacing Dopegit with a drug from another group.

Beta blockers

If a pregnant woman is worried about a heartbeat more than 100 beats per minute and high blood pressure, and the doctor diagnoses gestosis, he may prescribe her treatment with drugs from the group of beta blockers. Pindolol (Viske, Viskaldix) and Acebutolol (Acecor, Sectral) are currently considered the safest. Metoprolol, Labetolol and some other beta blockers may be prescribed with caution. Of the negative effects of the listed drugs for arterial hypertension, some weight loss is known in those newborns whose mothers took beta blockers.

Calcium channel blockers

Another group of drugs approved for the treatment of pregnant women are calcium channel blockers. Amlodipine, Nifedipine with slow release can be prescribed to women who have arterial hypertension, even in the first trimester of pregnancy. Women who have been prescribed Amlodipine give birth to children with increased body weight.

Diuretics

Arterial hypertension in pregnant women is sometimes treated with diuretics - Hypothiazide, Torasemide (Diuver). Diuretics not only themselves reduce blood pressure in arterial hypertension, they also enhance the effect of other drugs with a similar effect. However, due to possible blood thickening, diuretics are used in expectant mothers only after the doctor has weighed the pros and cons of such therapy.

Antihypertensive drugs during pregnancy

Drugs that have an antihypertensive effect during pregnancy must be used very carefully, strictly observing the dosage and duration of the course prescribed by the attending physician, in order to avoid negative effects on the fetus caused by insufficient blood supply to the placenta due to a decrease in blood pressure.

Alpha and beta blockers during pregnancy

Taking beta-blockers is prescribed to prevent premature termination of pregnancy.

There are good reasons to take these drugs:

• beta blockers quickly and effectively reduce blood pressure;
• the risk of side effects when taking drugs of this group for pregnant women is minimal;
• simultaneous use of alpha and beta blockers increases the effectiveness of therapy.

Taking these drugs is undesirable if blood pressure is unstable, due to the fact that they contribute to a sharp decrease in blood pressure.

Calcium antagonists during pregnancy

In the treatment of arterial hypertension syndrome, pregnant women are prescribed drugs - potassium antagonists, which help improve microcirculation and permeability of the heart muscle. These medications can be used no earlier than in the second trimester of pregnancy.

Calcium antagonists have a number of advantages: they minimize the likelihood of having children with insufficient body weight, are absolutely non-toxic to the child, and also reduce the frequency of preeclampsia in early pregnancy.

However, this group of antihypertensive drugs also has a number of disadvantages: blood pressure decreases too quickly, which threatens circulatory disorders in the placenta, the appearance of swelling of the extremities, allergic reactions and dyspeptic disorders.

Diuretics during pregnancy

Diuretic drugs (diuretics) in the treatment of hypertension in pregnant women help reduce blood pressure and eliminate edema. However, like all drugs, diuretics also have side effects associated with a deterioration in the flow of blood into the placenta due to a decrease in fluid volume, additionally caused by early and late gestosis. In addition, while taking diuretics, the electrolyte balance may be disrupted and the concentration of uric acid may increase, which has a negative effect on the condition of the placenta during gestosis.

Principles of treatment of arterial hypertension during pregnancy

Hypertension increases the risk of abruption of a normally located placenta, massive coagulopathic bleeding as a result of placental abruption, and can also cause eclampsia, cerebrovascular accident, and retinal detachment [1,12]. Recently, there has been an increase in the prevalence of hypertension during pregnancy due to its chronic forms against the background of an increase in the number of patients with obesity, diabetes mellitus and due to the increasing age of pregnant women. And vice versa - women who develop hypertensive disorders during pregnancy are subsequently at risk for developing obesity, diabetes, and cardiovascular diseases. Children of these women have an increased risk of developing various metabolic and hormonal disorders, cardiovascular pathology [1,4]. The criteria for diagnosing hypertension during pregnancy, according to WHO, are a systolic blood pressure (SBP) level of 140 mmHg. or more or diastolic blood pressure (DBP) 90 mm Hg. or more or an increase in SBP by 25 mm Hg. or more or DBP by 15 mm Hg. Art. compared with blood pressure levels before pregnancy or in the first trimester of pregnancy. It should be noted that during a physiologically occurring pregnancy in the first and second trimesters, a physiological decrease in blood pressure occurs due to hormonal vasodilation; in the third trimester, blood pressure returns to the normal individual level or may slightly exceed it [1,6,8]. The following 4 forms of hypertension in pregnant women are distinguished. • Chronic hypertension (this is hypertension or secondary (symptomatic) hypertension diagnosed before pregnancy or before 20 weeks). • Gestational hypertension (increased blood pressure levels, first recorded after 20 weeks of pregnancy and not accompanied by proteinuria). Most recommendations suggest observation for at least 12 weeks to clarify the form of hypertension and understand the further prognosis. after childbirth. • Preeclampsia/eclampsia (PE) (a pregnancy-specific syndrome that occurs after the 20th week of pregnancy, determined by the presence of hypertension and proteinuria (more than 300 mg of protein in daily urine). However, the presence of edema is not a diagnostic criterion for PE, t .k. during a physiologically proceeding pregnancy, their frequency reaches 60%. Eclampsia is diagnosed if convulsions occur in women with PE that cannot be explained by other reasons. • Preeclampsia/eclampsia against the background of chronic hypertension: a) appearance after 20 weeks. pregnancy, proteinuria for the first time (0.3 g of protein or more in daily urine) or a noticeable increase in previously existing proteinuria; b) progression of hypertension in those women who have up to 20 weeks. pregnancy blood pressure was easily controlled; c) appearance after 20 weeks. signs of multiple organ failure. According to the degree of increase in blood pressure in pregnant women, they distinguish between moderate hypertension (with SBP 140–159 mm Hg and/or DBP 90–109 mm Hg) and severe hypertension (with SBP >160 and/or DBP >110 mm Hg .st.). Distinguishing two degrees of hypertension during pregnancy is of fundamental importance for assessing the prognosis and choosing tactics for managing patients. Severe hypertension in pregnant women is associated with a high risk of stroke. Strokes in women develop equally often both during childbirth and in the early postpartum period and in 90% of cases are hemorrhagic; ischemic strokes are extremely rare. An increase in SBP is more important than DBP in the development of stroke. It was noted that in those women who developed a stroke during pregnancy, childbirth, or shortly after delivery, in 100% of cases the SBP value was 155 mm Hg. and higher, in 95.8% of cases – 160 mm Hg. and higher. Increase in DBP to 110 mm Hg. and higher was observed only in 12.5% ​​of patients who suffered a stroke [4,8,9]. The optimal blood pressure level is below 150/95 mmHg. In the postpartum period, the patient needs additional examination to identify the etiology of hypertension and assess the condition of target organs. After 12 weeks. after childbirth, the diagnosis of gestational hypertension with persistent hypertension should be changed to “hypertension” or one of the possible options for the diagnosis of secondary (symptomatic) hypertension. In cases of spontaneous normalization of blood pressure levels within up to 12 weeks. after childbirth, a diagnosis of transient hypertension is retrospectively established. There is evidence that the recovery period after childbirth in the majority of women who have suffered gestational hypertension and PE, regardless of the severity of hypertension, lasts quite a long time. After 1 month after childbirth, only 43% of these patients have normal blood pressure levels, and even after 6 months. In half of women, blood pressure levels remain elevated. After 3 months (12 weeks) of observation after childbirth, 25% of women who have undergone PE still have hypertension; after 2 years, 40% of these patients show normalization of blood pressure levels [1,4,9]. After identifying hypertension in a pregnant woman, the patient should be examined to clarify the origin of the hypertensive syndrome, determine the severity of hypertension, and identify concomitant organ disorders, including the condition of target organs, placenta and fetus. The examination plan for hypertension includes: – consultations with a general practitioner (cardiologist), neurologist, ophthalmologist, endocrinologist; – instrumental studies: electrocardiography, echocardiography, 24-hour blood pressure monitoring, ultrasound examination of the kidneys, Doppler ultrasound of the renal vessels; – laboratory tests: general blood test, general urinalysis, biochemical blood test (with lipid spectrum), microalbuminuria (MAU). If the diagnosis was not clarified at the stage of pregnancy planning, additional examinations are necessary to exclude the secondary nature of hypertension. If the data obtained are sufficient to clarify the diagnosis, exclude secondary hypertension, and on their basis it is possible to clearly determine the patient’s risk group in accordance with the stratification criteria used for chronic hypertension, and, consequently, the management tactics for the pregnant woman, then the examination can be completed. The second stage involves the use of additional examination methods to clarify the form of secondary hypertension, if any, or to identify possible concomitant diseases [6,8]. One of the most difficult tasks in the treatment of hypertension is the choice of pharmacological drug. In the treatment of hypertension in pregnant women, antihypertensive drugs are often considered, but they have practically lost their clinical significance in other categories of patients with hypertension. For ethical reasons, randomized clinical trials of drugs in pregnant women are limited, and there is virtually no information about the effectiveness and safety of most new drugs for the treatment of hypertension. The main drugs that have justified their use for the treatment of hypertension during pregnancy are central α2-agonists, β-blockers (β-blockers), the α-β blocker labetalol, calcium antagonists (CA) and some myotropic vasodilators [3,5 ,7,11]. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists are contraindicated during pregnancy due to the high risk of intrauterine growth retardation, bone dysplasia with impaired ossification of the cranial vault, shortening of the limbs, oligohydramnios, neonatal renal failure (renal dysgenesis, acute renal failure in fetus or newborn), fetal death is possible [11,14]. Most international and domestic recommendations recognize methyldopa as a first-line drug, which has successfully proven its effectiveness and safety for the mother and fetus; it is used in a dose of 500–2000 mg/day. in 2–3 doses. Despite penetration through the placental barrier, numerous studies have confirmed the absence of serious adverse effects in children. During treatment with the drug, uteroplacental blood flow and fetal hemodynamics remain stable, and perinatal mortality decreases. It was noted that methyldopa does not affect the cardiac output and blood supply to the kidneys in the mother. However, methyldopa has a number of significant disadvantages, mainly associated with its relative “outdatedness” - in comparison with modern antihypertensive drugs, it has much less effectiveness, a short period of action, a fairly large number of adverse reactions with long-term use (depression, drowsiness, dry mouth and orthostatic hypotension), it is characterized by a lack of organoprotective action. Methyldopa may exacerbate the disproportionate fluid retention that is already common during pregnancy. In addition, methyldopa can cause anemia due to a toxic effect on the red bone marrow or on the red blood cells themselves, resulting in hemolysis. When taking methyldopa, antibodies to red blood cells are detected in approximately 20% of patients with hypertension; clinically hemolytic anemia develops in 2% of patients, including children exposed to the drug in utero. In addition, children born to mothers taking methyldopa may develop hypotension in the first day of life [10,13,15]. Another first-line drug for the treatment of hypertension in pregnant women in most foreign guidelines is considered to be the non-selective β- and α-adrenergic blocker labetalol, but labetalol is not registered in the Russian Federation, so there is no experience of its use in our country. According to numerous studies, it is recommended for the treatment of hypertension of varying severity, and appears to be quite safe for the mother and fetus [9,11]. There is caution regarding the use of AKs due to the potential risk of developing teratogenic effects, because calcium is actively involved in the processes of organogenesis. The most studied drug of the AK group is a representative of the dihydropyridine group - nifedipine. Short-acting nifedipine is recommended as a means to quickly lower blood pressure. Extended-release tablets and controlled-release tablets are used for long-term, planned basic therapy of hypertension during gestation. The hypotensive effect of nifedipine is quite stable; in clinical studies, no serious adverse events were noted, in particular the development of severe hypotension in the mother [9,11]. Short-acting nifedipine, when used sublingually, in some cases can provoke a sharp uncontrolled drop in blood pressure, which leads to a decrease in placental blood flow. In this regard, even in emergency care, the drug should not be taken orally. Prolonged forms of nifedipine do not cause a pathological decrease in blood pressure levels, reflex activation of the sympathetic nervous system, and provide effective control over blood pressure levels throughout the day without a significant increase in its variability. In addition, ACs simulate hemodynamics characteristic of physiological pregnancy [3,11]. β-blockers are used as second-line drugs. Their use during pregnancy has been less studied than the use of labetalol. However, most of them, according to the FDA safety classification for use during pregnancy, are, like labetalol, in category C (“risk cannot be excluded”). One of the most significant advantages of drugs in this group is their high antihypertensive effectiveness, which was confirmed even when comparing them with labetalol. Thus, atenolol in a comparative study with labetalol caused a comparable hypotensive effect and did not cause teratogenic effects, bronchospasm or bradycardia. However, children born to mothers taking atenolol had lower body weight (2750±630 g) compared to the group of children whose mothers received labetalol (3280±555 g). Later, a number of other studies showed that antenatal use of atenolol was associated with slower intrauterine growth and lower birth weight. It should be noted that there is evidence of a decrease in the incidence of PE in patients taking atenolol. A study of 56 pregnant women showed that atenolol can reduce the incidence of PE in women with high cardiac output (more than 7.4 L/min before 24 weeks of gestation) from 18 to 3.8%. In 2009, it was revealed that in these women the concentration of fms-like tyrosine kinase type 1 (sFlt-1), recognized as the leading etiological factor of PE, decreases [2,7]. When using propranolol during pregnancy, multiple undesirable effects in the fetus and newborn have been described (intrauterine growth retardation, hypoglycemia, bradycardia, respiratory depression, polycythemia, hyperbilirubinemia, etc.), therefore the drug is not recommended for use during pregnancy. In many national recommendations, metoprolol is considered as the drug of choice among β-blockers in pregnant women, because it has proven to be highly effective, has no effect on fetal weight and has a minimal number of undesirable effects. Despite this, literature data allow us to discuss the possibility of using β-blockers with vasodilating properties as the drugs of choice [1,9]. Data from several randomized clinical trials generally suggest that β-blockers (β-blockers) are effective and safe as antihypertensive therapy in pregnant women. There is an opinion that beta-blockers prescribed in early pregnancy, especially atenolol and propranolol, can cause fetal growth retardation due to an increase in general vascular resistance. At the same time, in a placebo-controlled study using metoprolol, no data were obtained indicating a negative effect of the drug on fetal development. R. von Dadelszen in 2002 [16] conducted a meta-analysis of clinical studies on β-blockers and concluded that fetal growth retardation is not due to the effect of β-blockers, but to a decrease in blood pressure as a result of antihypertensive therapy with any drug, while all antihypertensive drugs are equally reduced the risk of developing severe hypertension by 2 times compared to placebo. When comparing various antihypertensive drugs with each other, no advantages were found regarding the effect on endpoints (development of severe hypertension, maternal and perinatal mortality). In connection with the above, in order to minimize side effects during gestation, it is advisable to give preference to cardioselective β-blockers with vasodilating properties, because this primarily avoids an increase in general peripheral vascular resistance and myometrial tone. The most promising for successful use in the treatment of hypertension in pregnant women is a highly selective β1-blocker with vasodilating and vasoprotective properties - bisoprolol (Bisogamma). By blocking β1-adrenergic receptors of the heart, reducing the formation of cAMP from ATP stimulated by catecholamines, bisoprolol reduces the intracellular current of calcium ions, reduces the heart rate, inhibits conductivity, and reduces myocardial contractility. With increasing dose, it has a β2-adrenergic blocking effect. In the first 24 hours after administration, it reduces cardiac output and increases total peripheral vascular resistance, which peaks after 3 days. returns to the original level. The hypotensive effect is associated with a decrease in minute blood volume, sympathetic stimulation of peripheral vessels, restoration of sensitivity in response to a decrease in blood pressure and an effect on the central nervous system. In addition, the hypotensive effect is due to a decrease in the activity of the renin-angiotensin system. In therapeutic doses, the use of Bisogamma does not have a cardiodepressive effect, does not affect glucose metabolism and does not cause sodium ion retention in the body. Bisogamma does not have direct cytotoxic, mutagenic or teratogenic effects. Its advantages in the treatment of hypertension during pregnancy are: gradual onset of hypotensive action, no effect on circulating blood volume, absence of orthostatic hypotension, reduction in the incidence of respiratory distress syndrome in the newborn. This drug has stable antihypertensive activity and has a mild chronotropic effect. Bisoprolol (Bisogamma) is characterized by high bioavailability, low individual variability in plasma concentrations, moderate lipophilicity and stereospecific structure, and a long half-life, which together makes it possible for its long-term use. The drug is characterized by a low discontinuation rate and the absence of side effects from biochemical, metabolic, renal and hematological parameters during long-term follow-up. Important advantages of this drug, especially when it comes to hypertension in pregnant women, are its high efficiency in correcting endothelial dysfunction and nephroprotective effect. There were no adverse effects of bisoprolol (Bisogamma) on the fetus, as well as on the health, growth and development of children during their first 18 months. life. Side effects of β-blockers include bradycardia, bronchospasm, weakness, drowsiness, dizziness, rarely depression, anxiety; in addition, one should remember the possibility of developing “withdrawal syndrome” [1,2]. Data from observational studies of bisoprolol (Bisogamma) suggest effectiveness and sufficient safety when used in the 2nd–3rd trimesters of pregnancy. In the Russian literature there is data on the effectiveness and absence of side effects of the use of bisoprolol, including as part of low -dose combined therapy, for the treatment of hypertension and heart rhythm disorders in pregnant women. No adverse effect on the fetus was noted [3]. In order to assess the influence of bisoprolol (bisogamma) on the level of daily blood pressure, the frequency of development of PE we examined 25 women aged 21–40 years with a pregnancy period of 20-30 weeks. and gestational ag. Bisoprolol (bisogamma) was used as antihypertensive drugs in a dosage of 2.5–5 mg/day. (13 women) - group 1 or Atenolol in a dosage of 25-50 mg/day. (12 women) - Group 2. Before and after a 4 -week course of hypotensive therapy, they performed a standard clinical and laboratory -diagnostic examination of the mother and fetus, daily blood monitoring. The hypotensive effects of Atenolol and Bisoprolol (Bisogamma) were comparable. The middle garden, when taking Atenolol, decreased from 158 to 121 mm Hg, DAD - from 102 to 80 mm Hg. Under the influence of Bisoprolol (Bisogamma), the middle garden decreased from 159 to 120 mm Hg. (p <0.01), DAD - from 121 to 78 mm Hg (p> 0.01). In the 3rd trimester, PE developed in 5 women group 2 and only in 1 patient of group 1. As a result of the study, it was concluded that Bisoprolol (Bisogamma) with gestational hypertension effectively reduces blood pressure and prevents the development of PE. Thus, the problem of AH in pregnant women is still far from permission and requires combining the efforts of obstetricians and therapists to select the optimal treatment method. Literature 1. Vertkin A.L., Tkacheva O.N., Murashko L.E. et al. Arterial hypertension of pregnant women: diagnosis, tactics of conducting and approaches to treatment. // Attending doctor. - 2006. - No. 3. - P. 25–8. 2. Osadchiy K.K. β -adrenoists for arterial hypertension: focus on bisoprolol // Cardiology. - 2010. - No. 1. - From 84–89. 3. Stryuk R.I., Brytkova Y.V., Bukhonkina Yu.M. et al. Clinical efficiency of antihypertensive therapy with prolonged nifedipine and Bisoprolol of pregnant women with arterial hypertension // Cardiology. - 2008. - No. 4. - S. 29–33. 4. Manukhin I.B., Markova E.V., Markova L.I., Stryuk R.I. Combined low -dos antihypertensive therapy in pregnant women with arterial hypertension and gestosis // Cardiology. - 2012. - No. 1. - p. 32–38. 5. CIFKOVA R. Who is the Treatment of Hypertension in Pregnancy Still So Difficult? // Expert Rev. Cardiovasc. Ther. 2011. Vol. 9 (6). P. 647–649. 6. Clivaz Mariotti L., Saudan P., Landau Cahana R., Pechere - Bertschi A. Hypertension in Pregnancy // Rev. Med. Suisse. 2007. Vol. 3 (124). P. 2015–2016. 7. Hebert MF, Carr DB, Anderson GD et al. Pharmacokinetics and Pharmacodynamics of Atenololo During Pregnancy and Postpartum // J. Clin. Pharmacol. 2005. Vol. 45 (1). P. 25–33. 8. LEEMAN M. Arterial Hypertension in Pregnancy // Rev. Med. Brux. 2008. Vol. 29 (4). P. 340–345. 9. Lindheimer MD, Taler SJ, Cunningham FG American Society of Hypertension. Ash Position Paper: Hypertension in Pregnancy // J. Clin. Hypertens. 2009. Vol. 11 (4). P. 214–225. 10. Mahmud H., Foller M., Lang F. Stimulation of Erythrocyte Cell Membrane Scrambling by Methyldopa // Kidney Blood Press Ress. 2008. Vol. 31 (5). P. 299–306. 11. Montan S. Drugs Used in Hypertensive Diseases in Pregnancy // Curr. Opin. Obstet. Gynecol. 2004. Vol. 16 (2). P. 111–115. 12. Mustafa R., Ahmed S., Gupta A., Venuto Rc a Comprehece Review of Hypertension in Preignancy // J. Pregnancy. 2012. Vol. 5 (3). P. 534–538. 13. Ozdemir OM, Ergin H., Ince T. A NewBorn with Positive Antiglobulin Test Whose Mother Methyldopa in Pregnancy // Turk. J. Pediatr. 2008. Vol. 50 (6). P. 592–594. 14. Podymow T., August P. Update on the Use of Antihypertensave Drugs in Pregnance // Hypertension. 2008. Vol. 51 (4). P. 960–969. 15. Seremak - Mrozikiewicz A., Drews K. Methyldopa in Therapy of Hypertension in Pregnant Women // Ginekol. Pol. 2004. Vol. 75 (2). P. 160–165. 16. Von Dadelszen P., Magee La Fall in Mean Arterial Pressure and Fetal Growth Restriction in Pregnancy Hypertension: An Updated Metaregrewsis // J. Obstet. Gynaecol. Can. 2002. Vol. 24 (12). P. 941–945.

Complications of arterial hypertension syndrome in pregnant women

The main danger of arterial hypertension syndrome during pregnancy is a hypertensive crisis. In addition, women are also at risk of other conditions that are dangerous to their health:

• plaques form on the walls of blood vessels, which leads to a significant disruption of the already impaired blood circulation and the supply of necessary substances to the placenta;
• High blood pressure can lead to myocardial infarction, resulting in the death of the child. This occurs due to narrowing of the coronary arteries and insufficient blood flow to the heart;
• arterial hypertension can cause pathological processes in the kidneys, and the development of renal failure may occur due to impaired blood circulation in the kidneys;
• due to impaired blood circulation, central nervous system pathologies may occur: possible development of stroke, chronic failure of brain circulation;
• In addition, pregnant women with arterial hypertension often experience the development of endocrine diseases, visual impairment, metabolic syndrome and many other serious complications.

If a hypertensive crisis occurs, a woman requires immediate treatment.

High blood pressure: is it so dangerous?

High blood pressure leads to changes in tissues and organs, primarily affecting the cardiovascular system. At the same time, the baby is also involved in this process - the mother’s pressure prevents the correct formation of organs, as a result of which the child may develop congenital defects of the heart, blood vessels, circulatory system, etc. So, what are the pathological conditions associated with high blood pressure in the mother? can affect the baby's health? As a result of hypertension, disturbances in the blood supply to the placenta occur - preeclampsia
.
The main symptoms to look out for are: persistent headaches, stomach pain, vision changes such as blurred vision, spots or lights, swelling of the face or hands, nausea or vomiting, sudden weight gain and breathing problems. Often, preeclampsia has no obvious symptoms. This is another reason why it is extremely important to receive regular prenatal care, monitor your blood pressure, and have urine and blood tests. They will help identify liver or kidney dysfunction. The most dangerous complication of preeclampsia is eclampsia
, a condition in which a woman’s blood circulation to the brain is impaired. This leads to a sudden seizure with severe convulsions and coma, which can result in the death of the mother or miscarriage.

The mother's pressure prevents the correct formation of organs, as a result of which the child may develop congenital defects of the heart, blood vessels, and circulatory system.

Arterial hypertension is not always an independent disease. Sometimes high blood pressure becomes a marker of another dangerous condition. One of these pathological conditions is gestosis
, which can provoke dysfunction of a woman’s vital organs.
The main symptoms of gestosis are high blood pressure, persistent swelling and increased protein content in the urine. With this complication during pregnancy, kidney function is disrupted, and eclampsia also develops, as mentioned above. By the way, currently there are not only personal tonometers, but also personal urine analyzers that reliably determine the protein content in the urine and can be connected to a smartphone. Another danger associated with high blood pressure is fetoplacental insufficiency
, in which the oxygen supply to the fetus is disrupted.
This is fraught with stopping its development and can lead to the death of the fetus. Premature placental abruption
is a complication also caused by high blood pressure. And if in the later stages, closer to childbirth, such a pathological condition can still be resolved favorably, then at the beginning or middle of pregnancy, premature birth ends in the death of the baby.