1.

SBP/DBP
Optimal < 120/80
Normal 120 129/80 - 84
Borderline 130 139/85 - 89
Hypertension 140/90
Stage 1 140 159/90 - 99
Stage 2 160 179/100 - 109
Stage 3 180/110
JNC 6 Category JNC 7 Category
Normal
Prehypertension
Hypertension
Stage 1
Stage 2
1. Chronic hypertension BP 140 mmHg systolic or 90 mmHg diastolic
prior to pregnancy or before 20 weeks gestation
Persists 12 weeks postpartum.

2. Preeclampsia BP 140 mmHg systolic or 90 mmHg diastolic
with proteinuria (300 mg/24 h) after 20 weeks
gestation.
Can progress to eclampsia (seizures)
More common in nulliparous women, multiple
gestation, women with hypertension for 4
years, family history of preeclampsia,
hypertension in previous pregnancy, renal
disease.
Classification of Hypertension in Pregnancy
2.
3.

3. Chronic hypertension New onset proteinuria after 20 weeks in
with superimposed woman with hypertension.
preeclampsia In a women with hypertension and
proteinuria prior to 20 weeks gestation :
~ Sudden 2-to 3-fold increase in -
proteinuria
~ Sudden increase in BP
~ Thrombocytopenia
~ Elevated AST or ALT

Classification of Hypertension in Pregnancy
4.
4. Gestational Hypertension without proteinuria occurring
Hypertension after 20 weeks gestation.
Temporary diagnosis
May represent preproteinuric phase of
preeclampsia or recurrence of chronic
hypertension abated in midpregnancy.
May evolve to preeclampsia.
If severe, may result in higher rates of
premature delivery and growth retardation
than mild preeclampsia.


Classification of Hypertension in Pregnancy
5. Transient Retrospective diagnosis
hypertension BP normal by 12 weeks postpartum
May recur in subsequent pregnancies
Predictive of future primary hypertension
ALT indicates alanine aminotransferase; AST, aspartate
aminotransaminase; BP, blood pressure
Classification of Hypertension in Pregnancy
5.
6.

Agent Comments

1. Methyldopa Preferred on the basis of long-term follow-up
studies supporting safety

2. BBs Reports of intrauterine growth retardation
(atenolol) Generally safe

3. Labetalol Increasingly preferred to methyldopa because
of reduced side effects

4. Clonidine Limited data
Treatment of Chronic Hypertension in Pregnancy
7.

5. Calcium antagonists Limited data
No increase in major teratogenicity
with exposure

6. Diuretics Not first-line agents
Probably safe

7. ACEIs, angiotensin II Contraindicated
receptor antagonists Reported fetal toxicity and death

ACEIs indicate angiotensin-converting enzyme inhibitor; BBs,
beta blockers.

Agent Comments
8.
Hydralazine 5 mg IV bolus, then 10 mg every 20 to 30
minutes to a maximum of 25 mg, repeat in
several hours as necessary.

Labetalol 20 mg IV bolus, then 40 mg 10 minutes later,
(second-line) 80 mg every 10 minutes for 2 additional
doses to a maximum of 220 mg.
Treatment of Acute Severe Hypertension in Preeclampsia
Nifedipine 10 mg PO, repeat every 20 minutes to a
(controversial) maximum of 30 mg.
Caution when using nifedipine with magnesium
sulfate, can see precipitous BP drop
Short-acting nifedipine is not approved by
US Food and Drug Administration for
managing hypertension.

Sodium 0.25 g/kg/min to a maximum of 5 g/kg/min.
Nitroprusside Fetal cyanide poisoning may occur if used for
(rarely when others fail) more than 4 hours.

Treatment of Acute Severe Hypertension in Preeclampsia
9.
10.

I. Vasodilators

1. Sodium 0.25-10 Immediate 1-2 min Nausea, Most hyper-
Nitroprusside g/kg/min vomiting, tensive
as IV infusion muscle, emergencies,
twitching, caution with
sweating, high intra-
thiocynate cranial
and cyanide pressure
intoxication or azotemia
Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
Parenteral Drugs for Treatment of Hypertensive Emergencies
2. Nicardipine 5-15 mg/h IV 5-10 min 15-30 Tachycardia, Most hyper-
hydrochloride min, may headache, tensive emer-
exceed 4 h flushing, gencies
local- except acute
phlebitis. heart failure;
Caution with
coronary
ischemia.
Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
11.
12.
3. Fenoldopam 0.1-0.3g/kg 5 min 30 min Tachycardia, Most hyper-
mesylate per min IV headache, tensive
infusion nausea, emergencies;
flushing. caution with
glaucoma.

4. Nitroglycerin 5-100g/min 2-5 min 5-10 min Headache, Coronary
as IV infusions vomiting, ischemia.
methemo-
globinemia
tolerance with
prolonged use.
Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications

5. Enalaprilat 1.25-5 mg 15-30 min 6-12 h Precipitous Acute left
every 6 h IV fall in ventricular
pressure high- failure;
renin states; avoid in-
variable acute
response. myocardial
infarction.
Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
13.
14.
6. Hydralazine 10-20 mg IV 10-20 min IV 1-4 h IV Tachycardia, Eclampsia
hydrochloride flushing,
headache,
vomiting,
aggravation
of angina.
10-40 mg IM 20-30 min IM 4-6 h IM

Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
15.
II. Adrenergic inhibitors.

1. Labetalol 20-80 mg IV 5-10 min 3-6 h Vomiting, Most hyper-
hydrochloride bolus every- scalp tingling, tensive
10 min broncho- emergencies
constriction, except acute
dizziness, heart failure.
nausea,
heart-block,
orthostatic
hypotension.
0.5-2.0 mg/min
IV infusion
Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
16.
2. Esmolol 250-500 1-2 min 10-30 min Hypo- Aortic-
hydrochloride g/kg/min tension, dissection,
IV bolus, nausea, peri-
then 50- 100 asthma- operative
g/kg/min first degree
by infusion; heart block,
may repeat HF
bolus after 5
min or increase
infusion to
300 g/min

Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
3. Phentolamine 5-15 mg IV 1-2 min 10-30 min Tachy- Catecho-
bolus cardia, lamine
flushing, excess
headache
Onset of Duration Adverse Special
Drug Dose Action of Action Effects Indications
17.