Management of hypertension in pregnancy

Antihypertensive treatment is well tolerated in pregnancy, with few women needing to change drugs due to side effects. Antihypertensive treatment for mild chronic hypertension benefits the mother, but the impact on perinatal outcomes is less clear, particularly for atenolol. For hypertension presenting later in pregnancy, even near term, the available data do not allow for reliable conclusions to be made about the benefits and risks of restricted activity with or without admission to hospital. Antihypertensive treatment for mild to moderate hypertension later in pregnancy benefits the mother, but the impact on perinatal outcomes may be harmful or beneficial. Women with early, severe pre-eclampsia have better perinatal outcomes if they are managed 'expectantly' but data are insufficient to estimate risks to the mother. For acute severe hypertension later in pregnancy, parenteral hydralazine is not the drug of choice as it is associated with more maternal and perinatal adverse effects than are other drugs, particularly intravenous labetalol or oral or sublingual nifedipine. Antihypertensive treatment given antenatally should probably be reordered postnatally.