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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Data from 38,636 pregnant women were studied to determine the best criteria for diagnosing pregnancy hypertension based on the constellation of clinical factors yielding poorest perinatal and long-term results to the offspring. It was found that the combination of maximum diastolic blood pressure and maximum proteinuria, as observed during the interval 28 weeks to term, provided the closest correlation with outcome. This information offered an objective means for establishing a classification of hypertension-hypotension in late pregnancy.
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PMID:Hypertension-hypotension in pregnancy. Correlation with fetal outcome. 65 Aug 4

The authors discuss some controversial aspects of the therapy of chronic hypertension in pregnancy. In cases in whom the blood pressure has been treated before conception the therapy should be continued. But there is no agreement about beginning of the hypotensive therapy during pregnancy. Some authors recommend an early treatment, others give hypotensive drugs only for those women who show no fall of the blood pressure in the second trimester or when the blood pressure exceeds 170/110 mm. Hg. These controversial opinions result from our defective notice of the uteroplacental blood flow during a long-continued application of antihypertensive drugs and their dose-response. As hypotensive agents methyldopa, hydralazine and beta adrenergic substances are recommended, on part of internists also medicaments which are used in nonpregnant patients. In severe chronic hypertension premature induction of labor is necessary. In hypertension III degree and IV degree the pregnancy should be interrupted.
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PMID:[Pros and cons in the therapy of hypertensive gestoses. II. Chronic hypertension]. 74 89

Oxytocinase and human placental lactogen (hPL) were measured in 705 serial maternal plasma samples collected from 74 patients whose pregnancies were complicated by hypertension. The trend and absolute levels of each substance were evaluated in a search for reliable antepartum indicators of intrauterine growth retardation (IUGR). There were 21 patients who were delivered of growth-retarded infants and the oxytocinase values were abnormal in 16 cases (75 per cent), while hPL levels were abnormal in 15 cases (71 per cent). There were 24 patients with subnormal placental weights. Abnormal oxytocinase values were observed in 17 (71 per cent) and abnormal hPL in 19 cases (79 per cent). The remaining 37 patients had "normal" fetal and placental weights. Abnormal oxytocinase values were observed in 15 patients (41 per cent) and abnormal hPL in 19 (52 per cent). In this group of pregnant mothers thought to be at risk for IUGR due to pregnancy hypertension, either test alone predicted subnormal neonatal or placental weight in about three fourths of cases. However, in the mothers with hypertension, who had no evidence of IUGR, false abnormal values of oxytocinase and hPL were found in nearly half the patients. No advantage was gained in the predictive accuracy when both tests were used.
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PMID:Oxytocinase and human placental lactogen for the prediction of intrauterine growth retardation. 92 Jul 68

To investigate the role of components of the renin-angiotensin-aldosterone system and plasma progesterone concentrations in the pathophysiology of hypertension in pregnancy, sequential measurements were made throughout pregnancy in 45 normotensive subjects, 41 other pregnant patients in whom hypertension became manifest only during pregnancy and 26 patients with chronic hypertension antedating pregnancy. Among the normotensive subjects plasma renin activity and substrate, plasma aldosterone and progesterone concentrations were elevated as early as the sixth week of gestation. While consistent, progressive, further increases were noted in renin substrate, aldosterone and pregesterone concentrations during pregnancy, plasma renin activity did not continue to rise. In both hypertensive groups, plasma renin activity and aldosterone concentration were significantly suppressed during the last trimester despite levels of renin substrate and progesterone that were not significantly different than those observed in normotensive pregnancy. These observations confirm earlier studies reporting suppression near term of plasma renin activity in toxemia and indicate from these prospective observations that they are secondary effects. These studies, in addition, demonstrate parallel suppression of plasma aldosterone concentration in toxemia. The current report also indicates that this suppression is not due to a decrease in renin substrate concentration and that a hypothesized deficiency of plasma progesterone, which was not observed in the hypertensive subjects, does not play a permissive role in the development of hypertension.
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PMID:Sequential changes in the renin--angiotensin--aldosterone systems and plasma progesterone concentration in normal and abnormal human pregnancy. 100 40

This summary of management of pill patients covers contraindications, individualizing pill formulations for normal women, and for diabetics, hypertensives, hyperlipidemics and those with personal or familial history of thrombophebitic or vascular disorders. The estrogen or progestagen balance of a pill can be selected to suit the individual. All patients beginning oral contraception should have pelvic exam, breast exam, cervical smear, fasting blood glucose, hematology and SMA-12, repeated in 3 months and yearly thereafter. Normally the pill causes transitory deterioration in glucose tolerance, increased growth hormone, a permanent change in insulin response, effects that are irreversible in 20% of users. Prediabetics should be given sequentials; diabetics should be followed weekly or monthly during oral contraception. Severe hypertension occurs in about 1% of pill users, but the risk is 4 times higher in women who had hypertension in pregnancy. Patients with increased personal or familial risk should be checked every 3 months and pills stopped immediately if blood pressure exceeds 150/100. In pill users cholesterol and free fatty acids remain normal, but lipoproteins, lecithins and triglycerides increase after 6 weeks to a plateau by 6-18 months, in proportion to estrogen dose. Since patients normally only discover hyperlipidemia after a clinical event such as xanthoma or vascular accident, those with related familial or personal history should have blood lipid studies every 3 months, and be given a progestagen only pill. Adolescents who are at high risk of pregnancy should receive progestagen or sequential pills, if their growth, bone age, hypothalamic function and reproductive organs are mature. The risk of idiopathic or posttraumatic thromboembolism is 3-9 times higher in pill users than in the normal population, but the only way of testing for risk in an individual is to do a detailed series of coagulation tests. Those predisposed should be given progestagen only or low dose pills.
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PMID:[Program of surveillance of patients under oral contraceptives]. 122 Jan 2

In a prospective study regarding conservative treatment of mild to moderate hypertension in pregnancy 5244 women were evaluated at delivery. Two hundred and fifty-eight (4.9%) were registered as hypertensive during pregnancy with a blood pressure (BP) greater than or equal to 140/90 mmHg. One hundred and ninety-six of these continued their pregnancy without medication and 96/196 were defined as preeclamptic (PE), 45/196 as chronic hypertensive (CH), and 55/196 as having gestational hypertension (GH). In 62/258 women antihypertensive treatment was initiated in the mean 6.5 (+/- 8.7) days after onset of hypertension, due to a BP greater than or equal to 150/100 mmHg. There was a later onset of hypertension in the untreated group, and BP at delivery differed in the untreated groups (p less than 0.001) with the lowest BP in women with mild GH. There was no difference in cesarean section rate in the mild hypertensive group as compared to the normal population. Birth weight and length of pregnancy were significantly lower in the untreated mild hypertensive group as compared to normal pregnant women (p less than 0.05). But in the subgroup with mild GH pregnancy length and birth weight did not differ from normal pregnancy. The conclusion from our study is that women with mild hypertension in pregnancy might refrain from antihypertensive therapy if they are closely observed during pregnancy and delivery, especially if there has been no hypertension before pregnancy and no proteinuria develops.
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PMID:Conservative treatment of mild and moderate hypertension in pregnancy. 132 42

Our aim was to assess the effect of the introduction of a day-care unit on the care of women with non-proteinuric hypertension in pregnancy. A randomised controlled trial was carried out on 54 women who presented at 26 weeks of pregnancy or later with non-proteinuric hypertension (systolic blood pressure 150-170 mm Hg and/or diastolic pressure 90-105 mm Hg on two occasions at least 15 min apart). 30 women were allocated to care by the day unit and 24 were managed according to the established practice of their clinicians without access to the day unit (control group). Women in the control group spent on average 4.6 times longer as inpatients (difference in mean stay 4.0 days [95% confidence interval 2.1-5.9 days]) than the day-unit group and were 8.8 times (95% CI 3.0-25.8) more likely to be admitted to hospital. Induction of labour was 4.9 times (95% CI 1.6-13.8) more likely in the control than in the day-unit group and the development of proteinuria 11.4 times (95% CI 1.8-71.4) more likely. The control group had a mean of 1.5 fewer hospital outpatient visits (95% CI 0.36-2.64). The groups did not differ in their use of antihypertensive drugs. Day-unit care for hypertension in pregnancy significantly reduced the need for and the length of antenatal inpatient admissions and the number of medical interventions, at the cost of an increase in outpatient attendances. Our results are further evidence that inpatient care does not improve outcomes or prevent the development of proteinuria in this disorder.
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PMID:Randomised controlled trial of day care for hypertension in pregnancy. 134 41

A total of 1275 consecutive cases of pregnancy-associated hypertension were registered in the Maputo Central Hospital (corresponding to 2.9% of a total of 43,794 city parturients). In the hypertensive and in the reference populations the following prevalence figures were registered, respectively: age below 25 years, 52% and 23% (P < 0.0005); nulliparity, 33% and 19% (P < 0.0005); twin pregnancies, 3.9% and 1.7% (P < 0.0005); stillbirths, 5.7% and 2.3% (P < 0.0005); and low birthweight (LBW), 22.9% and 10.7% (P < 0.0005). In the hypertensive population the prevalence of LBW newborns was 20.1% in the liveborn group, while it was 68.4% in the stillborn group (P < 0.0005). In the ongoing perinatal audit it was found useful to review hypertensive women separately, in order to assess current routines in cases of pregnancy hypertension.
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PMID:Pregnancy-associated hypertension in Maputo. A study on maternal characteristics and perinatal outcome in 1275 consecutive cases. 135 98

The literature dealing with screening for hypertension in pregnancy was reviewed. No level of blood pressure or any other factor provides a guarantee of no risk for the development of preeclampsia. However, higher blood pressure in early pregnancy and a failure to decrease blood pressure in mid-pregnancy are both associated with the development of preeclampsia. The development of proteinuria, rather than the level of blood pressure, is the best predictor of poor pregnancy outcome. Multiparas, especially those with severe chronic hypertension who develop preeclampsia, are at greatest risk of poor pregnancy outcome.
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PMID:Screening for hypertension in pregnancy. 142 47

The treatment of hypertension in pregnancy is justified by the need to reduce blood pressure in order to avoid the onset of preeclampsia, eclampsia, retarded intrauterine growth and even neonatal, perinatal and maternal death. The value of using drugs to treat slight-moderate hypertension in pregnancy is, however, not clearly defined in the literature. In fact, from an etiopathogenetic point of view, the significance of increased blood pressure in pregnancy has not yet been satisfactorily explained, and above all the positive significance of increased blood pressure not be forgotten since, up to diastolic levels of 90 mmHg, it is accompanied by an increase in birth weight. The aim of the present study was to verify the efficacy of pharmacological treatment in cases of slight-moderate hypertension during pregnancy in a population of 121 pregnant women attending the Obstetrics-Gynecological Clinic of the "Istituto per l'Infanzia" in Trieste during the period from 14-11-1984 to 24-4-1991. Data for this retrospective study were extrapolated from an analysis of medical records and then memorized in a data-base file. The degree of hypertension was classified as slight, moderate and severe according to blood pressure levels measured on hospitalisation. Clinical signs taken into account included: edema, proteinuria and hypoprotidemia. Anti-hypertensive therapy was selected between one or more associated drugs belonging to the following classes: central action and peripheral action anti-adrenergic drugs, beta-blockers, calcium channel blockers, vasodilators, diuretics, ACE-inhibitors and sedatives. Moreover, patients also received non-pharmacological treatment in the form of low sodium diets and bed-rest.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Moderate arterial hypertension in pregnancy: therapeutic aspects]. 148 Mar 1


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