High Blood Pressure Treatment (cont.)
In this Article
Emergency treatment of high blood pressure
In a hospital setting, injectable drugs may be used for emergency treatment of hypertension. The most commonly used are sodium nitroprusside (Nipride) and labetalol (Normodyne). Emergency medical therapy is needed for patients with severe (malignant) hypertension and in patients with short duration (acute) congestive heart failure, dissecting aneurysm (dilation or widening) of the aorta, stroke, and toxemia of pregnancy (see below).
Treatment during pregnancy
Pregnant women may develop hypertension or may have it already before
conception. These patients have an increased risk of developing preeclampsia or eclampsia (toxemia of pregnancy). These conditions usually develop during the last three months (trimester) of pregnancy. In preeclampsia, which can occur with or without pre-existing hypertension, affected women have hypertension, protein loss in the urine (proteinuria), and swelling (edema). In eclampsia convulsions also occur and the hypertension requires emergency treatment. The baby must be delivered quickly as part of the treatment of the mother. The main goal of treating the high blood pressure in toxemia is to keep the diastolic pressure below 105 mm Hg in order to prevent a brain hemorrhage or seizures in the mother.
Hypertension that develops before the 20th week of pregnancy is almost always due to pre-existing hypertension and not toxemia. High blood pressure that occurs only during pregnancy, called gestational hypertension, may start late in the pregnancy. These women do not have proteinuria, edema or convulsions and gestational hypertension appears to have no ill effects on the mother or fetus. This form of hypertension resolves shortly after delivery, although it may recur with subsequent pregnancies.
The use of medications for hypertension during pregnancy is controversial. The key question is, "At what level should the blood pressure be maintained?" The risk of untreated mild to moderate hypertension to the fetus or mother during pregnancy probably is not very large. Lowering the blood pressure too much can interfere with the flow of blood to the placenta and impair fetal growth. So, a compromise must be met. Not all mild or moderate hypertension during pregnancy needs to be treated with medication. If it is treated, the blood pressure should be reduced slowly and not to very low levels, not below 140/80.
Anti-hypertensive agents used during pregnancy need to be safe for normal fetal development. Beta-blockers, hydralazine (a vasodilator), labetalol (Normodyne, Trandate), alpha-methyldopa (Aldomet), and more recently, calcium channel blockers have been approved as suitable medications for hypertension during pregnancy. Some anti-hypertensive medications are not recommended (contraindicated) during pregnancy. These include ACE inhibitors, ARB drugs, and diuretics. ACE inhibitors may aggravate a diminished blood supply to the uterus (uterine ischemia) and cause kidney dysfunction in the fetus. ARB drugs may lead to death of the fetus. Diuretics can cause depletion of blood volume and impair placental blood flow and fetal growth.
Next: Which medications are used to treat high blood pressure »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Congestive Heart Failure - Read about congestive heart failure symptoms like fatigue, abdomen, leg and ankle swelling, shortness of breath, sleeplessness, increased urination, nausea, abdominal pain, and decreased appetite.
- Beta Blockers - Learn more about Beta Blockers, a drug that treats angina and other heart rhythm disorders, migraines, high blood pressure, panic attacks, and tremors. Generic and brand names are included in the article.
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