For the foregoing reasons, chronic hypertension would logically be deined as some level of sustained resting blood pressure that is associated with acute or long-term adverse efects. In this regard, most consider 140/90 mm Hg as the upper limit of normal for blood pressure values. But, in the United States, these values are based primarily on actuarial tables constructed using data derived from white adult males and compiled by life insurance companies. These "norms" disregard interrelated factors such as ethnicity, gender, and other important covariants. he importance of race, for example, was emphasized by Kotchen (2015), who cites the incidence of hypertensiondeined as blood pressurea> 140/90 mm Hg-to be 34 percent in blacks, 29 percent in whites, and 21 percent in Mexican Americans.
For many years, the Joint National Committee has promulgated guidelines for diagnosis, classification, and management of chronic hypertension. In 2008, the National Heart, Lung, and Blood Institute discontinued these guidelines, and the Joint National Committee 8 GNC 8) was instead asked to provide an evidence-based review Games, 2014). Findings pertinent to caring for young women with chronic hypertension are summarized in Table
Proven benefits accrue with treatment of otherwise normal adults who have sustained hypertension. Numerous studies evaluating many combinations of antihypertensive therapy have been conducted. Importantly, these trials evaluated monotherapy versus combination therapeutic regimens and their ethnospecific beneits. Most evaluated cardiovascular outcomes, but many also confirmed risk reductions in rates of cerebrovascular accident, renal insuficiency, and mortality. Because of these incontrovertible beneits, the JNC 8 recommends the management outlined in Table 50-1.
Thus, even for mildly elevated blood pressure, interventions to reduce these sequelae are beneficial (SPRINT Research Group, 2015). Moreover, antihypertensive therapy in nonpregnant reproductive-aged women with sustained diastolic pressures ::90 mm Hg is considered standard. Not clear from these observations, however, is what constitutes the best management for women being treated who contemplate pregnancy, for those undergoing treatment who become pregnant, or for those first identified to have chronic hypertension during pregnancy (August, 2015). In these women, the benefits and safety of instituting antihypertensive therapy are less clear, as subsequently discussed on page 981.
Women with chronic hypertension are ideally counseled before pregnancy. The duration of hypertension, degree of blood pressure control, and current therapy are ascertained. hose women who require multiple medications for control or those who are poorly controlled carry greater risk for adverse pregnancy outcomes. Home measurement devices are checked for accuracy. General health, daily activities, and dietary habits are also assessed (Table 50-2).
For hypertensive women with disease lasting longer than 5 years or with comorbid diabetes, cardiovascular and renal function is assessed (August, 2015; Gainer, 2005). Women with evidence for organ dysfunction or those with prior adverse events such as a stroke, myocardial infarction (MI), arrhythmias, or ventricular failure are at markedly higher risk for a recurrence or worsening dysfunction during pregnancy. Renal function is evaluated by serum creatinine measurement. Also, if
TABLE 50-1. Eighth Joint National Committee (JNC 8}-2014 Chronic Hypertension Guidelines and Recommendations
Lifestyle modifications endorsed from the Lifestyle Work Group (Eckel, 2013)
Recommend selection among four specific medication classes: angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-receptor blockers (ARB), calcium-channel blockers, or diuretics: