Pregnancy in the chronically hypertensive patient

The hypertensive disorders of pregnancy include a spectrum of disorders in which presentation, maternal and fetal risks, and pregnancy prognosis vary widely. The Working Group on High Blood Pressure in Pregnancy recently recommended a classification system to describe these disorders that was originally suggested by the American College of Obstetricians and Gynecologists in 1972.(29) This system identifies four categories of hypertensive disorders in pregnancy: (1) preeclampsia and eclampsia; (2) chronic hypertension; (3) preeclampsia superimposed on chronic hypertension; and (4) transient hypertension.(13) Although this classification scheme is not universally accepted (particularly outside of the United States), it is helpful for building a consensus among obstetricians and internists on controversial diagnostic and therapeutic issues. This review focuses on the diagnosis and management of chronic hypertension during pregnancy. Women with chronic hypertension are at increased risk for adverse pregnancy outcome. This is particularly true for patients with severe hypertension or associate end-organ disease. This article reviews these risks and discusses management issues with a particular focus on pharmacologic management.