[Treatment of hypertension in pregnancy. How long is ambulatory treatment enough?]

Hypertension in pregnancy is diagnosed when pressures in excess of 140/90 mmHg are repeatedly measured. A differentiation is made between pregnancy-independent hypertension, i.e. pre-existing hypertension and gestational hypertension occurring for the first time after the 20th week of the pregnancy. If hypertension is accompanied by proteinuria, the diagnosis of pre-eclampsia is made. Feared complications are eclampsia and the HELLP syndrome. For blood pressure measurement, a number of peculiarities must be noted: thus, for example, in severe pre-eclampsia the circadian rhythm may reverse, with pressure increases in particular in the evening and at night. Ambulatory management may be permissible only in the case of pre-pregnancy and gestational hypertension, provided the blood pressure can be kept below 160/100. Restricting physical activity, and regular monitoring of weight, blood pressure and laboratory investigations usually suffice. If pre-eclampsia or the HELLP syndrome is suspected, the patient should be hospitalized without delay. A hypertensive crisis must prompt immediate measures to lower the blood pressure--but not too quickly, in order to avoid severe consequences for the fetus caused by inadequate uteroplacental perfusion.