Do Pregnant Women Need Treatment for High Blood Pressure?

In the January 29th issue of the New England Journal of Medicine a clinical trial was published that claims that while babies aren’t affected by more intensive blood pressure treatments, they could lower the odds of mom developing severely high blood pressure.
The findings are based on nearly 1,000 pregnant women from 16 different countries who suffered from high blood pressure. Half received “tight” blood pressure control, and half received “less tight” control.
“If less-tight control had no benefit for the baby, then how do you justify the risk of severe [high blood pressure] in the mother?” said the study’s lead researcher, Dr. Laura Magee, of the Child and Family Research Institute and the University of British Columbia in Vancouver, Canada.
While high blood pressure is dangerous, current international guidelines on managing it during pregnancy vary. The advice from the American College of Obstetricians and Gynecologists (ACOG) is a “less-tight” approach, according to Dr. James Martin, a past president of the ACOG.
High blood pressure, also known as hypertension, is highly common in pregnant women affecting about 10% of them. According to Magee, the long standing question has been whether or not doctors should attempt to normalize blood pressure numbers – as they would with a patient who was not pregnant – or less aggressively.
According to studies, the danger lies in reducing blood flow to the placenta, which can occur if the mother’s blood pressure was to reduce too greatly. If that were to occur it could impair fetal growth.
High blood pressure is defined as above 140/90 mm HG. Treatment involved constant blood pressure monitoring, and medication for most women. The dose was adjusted when needed.
By the end of the study almost 41 percent of women who received looser blood pressure control eventually developed severe high blood pressure, while just 27.5 percent of women following the tighter regimen developed it. One woman on the stronger regimen did suffer a stroke during the clinical trial.
“Before this study, I was for less-tight control,” Magee said, “Now I’ve changed my practice.” Until now studies on this subject have been small and low quality. According to Magee, current professional guidelines vary because of a lack of strong clinical evidence.
How do you feel about hypertension? Would you prefer a strict or “less-tight” approach to blood pressure monitoring during pregnancy? Share your thoughts in the comment section below. Don’t forget to share this article with your friends on Facebook & Twitter.