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Severe Chronic Hypertension in Pregnancy: A Case-Based Review of Management and Outcomes
Tyler Lueck1,2, Melissa H Spiel1,2
1Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Abstract:
Chronic hypertension complicates 1 to 2% of pregnancies and significantly increases maternal and fetal morbidity. This review presents a patient case of severe chronic hypertension with multiple comorbidities, requiring 5 antihypertensive agents for blood pressure control, culminating in preterm delivery for fetal compromise. We discuss current definitions, risks, treatment options, and key clinical trials (Chronic Hypertension and Pregnancy, Hypertension and Preeclampsia Intervention Trial at Near Term-II) for the management of hypertension in pregnancy, highlighting gaps in the management of severe, refractory cases of chronic hypertension.
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