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Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BJH, Regitz-Zagrosek V, de Simone G. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 6:384-393. [PMID: 31841131 DOI: 10.1093/ehjcvp/pvz082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks' gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic.,Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Mark R Johnson
- Institute of Reproductive and Developmental Biology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jana Brguljan
- Division of Internal Medicine, Department of Hypertension, Medical Faculty, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Bryan Williams
- UCL Institute of Cardiovascular Sciences, University College London, London, UK
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Costas Thomopoulos
- Department of Cardiology, Helena Venizelou General & Maternal Hospital, Athens, Greece
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S.Luca Hospital, Milan, Italy
| | - Isabella Sudano
- Department of Cardiology, University Heart Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Bert-Jan H van den Born
- Departments of Internal and Vascular Medicine, Department of Public Health, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Vera Regitz-Zagrosek
- Berlin Institute for Gender in Medicine and CCR, Charité University Medicine Berlin, and DZHK, Partner Site Berlin, Germany
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Hypertension Research Center, Federico II University, Naples, Italy
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Rath W, Tsikouras P, Schlembach D. [Ambulatory and Home Blood Pressure Measurement in Hypertensive Pregnant Women]. Z Geburtshilfe Neonatol 2020; 224:333-338. [PMID: 33276403 DOI: 10.1055/a-1266-7401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of hypertensive disorders in pregnancy (HDP) is 6-8%. Blood pressure measurement (BPM) remains the cornerstone of diagnosis and should be performed in a standardised manner using automated devices. Office BPM represents only a spotty reading in an "artificial" environment failing to diagnose white coat hypertension (WCH). Ambulatory and home blood pressure measurement (ABPM/HBPM) are recommended for the diagnosis and differentiation of hypertension as well as for blood pressure and therapy control in women with HDP. Patient compliance is crucial for the use of both methods. ABPM is an appropriate method for the early identification of WCH and masked hypertension as well as for differentiating WCH from chronic hypertension < 20 week's gestation. HBPM has been shown to reduce the number of antenatal visits and hospital admissions compared to office blood pressure measurement without compromising maternal and fetal outcomes; it also avoids unnecessary antihypertensive medications and reduces the rate of labour inductions and false diagnosis of "preeclampsia". Problems associated with ABPM are its limited availability and inconvenience to patients due to sleep disturbances. Disadvantages of HBPM are the need for patient training, potential measurement errors, and the lack of evidence-based BP thresholds. The widespread use especially of HBPM may contribute to a reduction in workload of obstetric staff in the hospital and may save hospital expense.
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Affiliation(s)
- Werner Rath
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Komotini, Greece
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Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1090] [Impact Index Per Article: 181.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Diagnostic, évaluation et prise en charge des troubles hypertensifs de la grossesse : Résumé directif. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S426-S452. [DOI: 10.1016/j.jogc.2016.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chohan K, Delgado M, Atkinson M, Cong A, Mcgee T. Blood pressure profile in pregnancy: The impact of its duration on results and patients' well-being. Aust N Z J Obstet Gynaecol 2016; 56:295-300. [PMID: 26941062 DOI: 10.1111/ajo.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND A blood pressure profile (BPP) is often used to diagnose and manage hypertension in pregnancy. However, there is no consensus on the number and interval of blood pressure (BP) readings required. AIMS To ascertain whether BP readings at 15-min interval over one hour yields clinically equivalent results to readings at 60-min interval over three hours. MATERIALS AND METHODS Eighty unique women were recruited to this prospective study. Automated BP machines were used to take readings at 15-min interval over one hour and at 60-min interval over three hours. The mean systolic and diastolic BPs obtained using each regimen were calculated and compared. Women also completed a questionnaire to evaluate the psychosocial and financial impact of a prolonged outpatient investigation. RESULTS BP readings from 67 patients were included for analysis. Clinical equivalence was assessed using the British Hypertension Society (BHS) validation criteria for comparing nonmercury devices to the gold-standard calibrated mercury device. Mean SBP readings for 54% (36/67), 90% (60/67) and 97% (65/67) and mean DBP readings for 73% (49/67), 94% (63/67) and 100% (67/67) were within 5, 10 and 15 mmHg agreement across the two time regimens which achieved grade B and grade A validation, respectively. A BPP was costly and stressful for women and affected their ability to attend work and look after other children. CONCLUSIONS A BPP performed over one hour compared to over three hours yields clinically equivalent results, yet has psychosocial and financial advantages.
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Affiliation(s)
- Komal Chohan
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Melissa Delgado
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Monique Atkinson
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Angela Cong
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Therese Mcgee
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
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Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, Paech M, Said JM. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015; 55:e1-29. [PMID: 26412014 DOI: 10.1111/ajo.12399] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.
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Affiliation(s)
- Sandra A Lowe
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Lucy Bowyer
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Karin Lust
- Department of Obstetric Medicine and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Morton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Michael Paech
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Joanne M Said
- Sunshine Hospital and University of Melbourne, Melbourne, Victoria, Australia
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Audibert F, Bujold E, Côté AM, Douglas MJ, Eastabrook G, Firoz T, Gibson P, Gruslin A, Hutcheon J, Koren G, Lange I, Leduc L, Logan AG, MacDonell KL, Moutquin JM, Sebbag I. The hypertensive disorders of pregnancy (29.3). Best Pract Res Clin Obstet Gynaecol 2015; 29:643-57. [DOI: 10.1016/j.bpobgyn.2015.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 36:416-41. [PMID: 25184972 DOI: 10.1016/s1701-2163(15)30588-0] [Citation(s) in RCA: 333] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4:105-45. [PMID: 26104418 DOI: 10.1016/j.preghy.2014.01.003] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/17/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP). EVIDENCE The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Centre, Amsterdam, The Netherlands
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Huda SS, Freeman DJ, Nelson SM. Short- and long-term strategies for the management of hypertensive disorders of pregnancy. Expert Rev Cardiovasc Ther 2014; 7:1581-94. [DOI: 10.1586/erc.09.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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