Best practices suggest that women with severe hypertension, defined as blood pressure of ≥ 160 mmHg systolic or ≥ 110 mmHg diastolic in pregnancy (or postpartum), should be treated with antihypertensive therapy. The World Health Organization (WHO) ‘Prevention and Treatment of Pre-eclampsia and Eclampsia’ report strongly recommends use of antihypertensive therapy for treatment of severe hypertension during pregnancy, because treatment of severe hypertension in pregnancy or postpartum decreases maternal risk, particularly that of stroke. This has been demonstrated in the ‘Confidential Enquiries into Maternal Deaths’ in the UK (2009-12) and through a similar process in South Africa. Antihypertensive therapy for non-severe pregnancy hypertension decreases the risk of severe hypertension and the associated risks.
PRE-EMPT studies have established an evidence base for:
- What is the effect on pregnancy complications of ‘less tight control’ (target diastolic blood pressure, 100 mm Hg) vs ‘tight control’ (target diastolic blood pressure, 85 mm Hg)? Pregnancy hypertension (the Control of Hypertension in Pregnancy [CHIPS] Trial)
- Which oral antihypertensive can be administered to safely decrease blood pressure and prevent adverse maternal, foetal and neonatal outcomes? (the Gynuity Oral Antihypertensive Trial)