High Blood Pressure Treatment (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
Emergency treatment for 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), labetalol (Normodyne), and nicardipine (Cardene). 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 before conception. These patients have an increased risk of developing preeclampsia or eclampsia (toxemia of pregnancy). These conditions usually develop during the last 3 months (third 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, seizures 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 almost always is 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. Women with gestational hypertension do not have proteinuria, edema, or convulsions, and there appears to be 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 risk of untreated mild to moderate hypertension to the fetus or mother during pregnancy probably is not very great. Lowering the blood pressure too much can interfere with the flow of blood to the placenta and impair fetal growth. 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.
Antihypertensive 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 antihypertensive 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.
Reviewed by Jay W. Marks, MD on 10/11/2012
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