Hypertension in pregnancy: advances and controversies

Advances in prenatal care have resulted in a substantial decline in the number of serious complications associated with high blood pressure during pregnancy. Nevertheless, the hypertensive disorders remain a significant cause of maternal and fetal morbidity, and even mortality [Rochat et al. 1988]. In addition, hypertension in pregnancy is a topic that generates considerable controversy, ranging from the correct manner to measure blood pressure in gravidas, to major disputes concerning management considerations. The pervasiveness of such controversies [Cunningham and Pritchard 1984, Ferris 1984, Disdale 1988, Kaplan et al. 1988] led the United States' National Institutes of Health, through its National High Blood Pressure Education Program, to convince a working group whose "consensus" report has just been published (1990), and is recommended reading for physicians who manage gravidas. This review focuses on preeclampsia, and includes observations concerning the pathogenesis of this disorder as well as strategies to prevent its occurrence. Conflicting opinions regarding the management of preeclamptic women will also be discussed, highlighting the recommendations made by the NIH consensus group (NHBPEP 1990). Space considerations limit the references cited, and the reader is referred to a chapter [Barron 1991] and several texts [Chesley 1978, Rubin 1988] for a more complete survey of the literature.