How to control blood pressure in pregnancy for chronic hypertension, preeclampsia and superimposed preeclamsia?
This is the way>>>>
1. Labetalol ( Control blood pressure in pregnancy ) :
Combined alpha- & beta-blocker, 100 mg twice daily, increase by 100 mg twice daily every 2-3 days as needed.
Usual effective dose range is 200-800 mg in 2 divided doses. Maximum total daily dose 2400 mg. In acute situations, give labetalol 20 mg IV over 2 minutes. Repeat BP measurement at 10-minute intervals & if still high give the following doses at the same order after every
10 minutes till controlling BP is established; give 40, 80, 80, 80 mg to achieve a cumulative maximum dose of 300 mg & you can stop at any step once BP is controlled. If still high BP, add nifedipine as mentioned down.
(In my practice; for long-term use, I start 200 mg twice daily & if over controlled
decrease the dose to 100 mg twice daily, but if insufficient to control BP, increase the dose to 200 mg 3 times/daily, then 4 times/day acc. to your needs. As regard acute situations, I can give the IV dosing mentioned up & if not available, I give oral doses instead, in the same way 200 mg once then assess BP at 30 minutes intervals instead of 10 minutes in IV dosing).
2. Nifedipine extended release ( Control blood pressure in pregnancy ) :
Calcium channel blocker, 30-60 mg once daily as an extended release tablet, increase at 7-14 day intervals. Usual effective dose range 30-90 mg/day. Maximum total daily dose 120 mg.
(In my practice; I reserve it for the resistant cases not controlled by labetalol alone i.e if pt on labetalol 200 mg 4 times daily & still BP >145/90, I decrease the labetalol dose to 200 mg 3 times daily & add nifedipine 20 mg 2 times daily & if still high BP, increase the
nifedipine dose to 60 mg sustained release once daily with the 3 times daily labetalol. If BP still high, increase the labetalol dose to 200 mg 4 times daily+nifedipine 60 mg once daily & TERMINATE this case once BP is stabilized even if she is asymptomatic or very early preterm e.g 27 wk only & don’t forget to screen for thrombophilia after delivery 😮 )
3. Hydralazine ( Control blood pressure in pregnancy ) :
Peripheral vasodilator, usually reserved only for acute shooting BP, not for long-term use.
(In my practice, I don’t like it at all even in acute situations as it can cause profound
maternal hypotension & predispose to fetal distress & even IUFD.
4.Methyldopa ( Control blood pressure in pregnancy ) :
Centrally acting alpha-agonist, 250 mg 2-3 times daily, increase every 2 days as needed & take care; the full hypotensive effect of an initial dose or adjustment of
methylodopa may not occur until after 2-3 days of continuous use. Usual effective dose is 250-1000 mg in 2-3 divided doses daily & maximum total daily dose is 3000 mg/daily. (In my practice, I don’t use it dt. weak & slow effect & the extrapyramidal side effects beside it predispose to postpartum depression).
– There is big controversy regarding the target BP & at the end they put the target should be less than 150-130/100-80.
(In my practice, I start small doses once BP reach 145/95)
– For women with complicated or secondary hypertension (eg, target-organ damage as left ventricular hypertrophy, microalbuminuria, retinopathy, dyslipidemia, maternal age >40 years, history of stroke, previous perinatal loss, diabetes), we suggest treatment of HTN,
even if mild (Grade 2C). Our treatment target is systolic pressure 140-120/90-80.
How to control blood pressure in pregnancy