Chronic Hypertension in Pregnancy
Chronic hypertension in pregnancy is defined by the American College of Obstetrics and Gynecology (ACOG) as blood pressure ≥140 mm Hg systolic and/or 90 mm Hg diastolic before pregnancy or, in recognition that many women seek medical care only once pregnant, before 20 weeks of gestation, use of antihypertensive medications before pregnancy, or persistence of hypertension for >12 weeks after delivery.1 Chronic hypertension needs to be distinguished from new-onset hypertensive complications of pregnancy such as preeclampsia (elevated blood pressure and proteinuria often accompanied by evidence of maternal organ injury and fetal compromise from placental dysfunction)2 and gestational hypertension (elevated blood pressure alone after 20 weeks of gestation and most commonly in the mid to late third trimester without evidence or history of hypertension before pregnancy; Table 1).
Chronic hypertension is estimated to be present in ≈3% to 5% of pregnancies1,3,4 and is increasingly more commonly encountered. Factors contributing to the increase in prevalence include 2 major risk factors for hypertension, obesity and older age, which are of increasing prevalence in pregnancy. These shifts in risk and childbearing have resulted in an increased number of women who will require counseling on the risks of chronic hypertension in pregnancy and management of their antihypertensive medications both in anticipation of and during pregnancy.5 Because many pregnancies are unplanned,6 all women with chronic hypertension should receive regular counseling so that they can anticipate any issues that may arise if they become pregnant and optimize their health and care to temper risk. Because blacks have a higher prevalence of chronic hypertension7 and onset occurs at younger ages,8 it is more common to encounter chronic hypertension in blacks during pregnancy.
Despite its increasing prevalence, the majority of women …