The treatment of hypertension in pregnancy

The hypertensive disease that occurs during pregnancy is a multifaceted clinical condition whose accurate diagnosis, not limited to the evaluation of degree of the hypertensive derangement, is crucial for a correct therapeutic approach. In particular, chronic hypertension pre-existing before pregnancy should be clearly differentiated from the hypertensive disease induced by pregnancy and particularly from pre-eclampsia. Non-pharmacological measures of intervention have not been proven to improve both maternal and fetal outcome. Severe hypertension during pregnancy (blood pressure > 170/110 mmHg) should be immediately treated with drugs that have been proven to prolong pregnancy and to improve both maternal and fetal outcome. In patients with mild to moderate hypertension, both chronic and pregnancy induced, antihypertensive treatment improves the maternal outcome, whereas no clear-cut evidence of benefit have been reported at the fetal level. Among the different antihypertensive drugs that have been reported to be effective, safe and well tolerated during pregnancy, methyldopa, beta-blockers and particularly calcium channel blockers (nifedipine) represent the more suitable solution.