Hypertension and the obstetrician-gynecologist

Hypertension is a major risk factor for cardiovascular-related morbidity and death. Antihypertensive therapy markedly reduces the risk caused by elevated blood pressure. Earlier treatment of hypertensive patients should reduce deaths and morbidity even further. The obstetrician-gynecologist has the opportunity and responsibility to identify hypertensive patients early in the course of their disease. He must also confront the problem of elevated blood pressure associated with the use of oral contraceptives. In addition to its impact on the general population, chronic hypertension presents special problems during pregnancy. Pregnant women with elevated blood pressure have an increased fetal mortality rate and develop pre-eclampsia more frequently and earlier than nonhypertensive women. Antihypertensive treatment possibly increases fetal survival; when used appropriately, it definitely does not decrease fetal salvage. The appropriate use of antihypertensive therapy during pregnancy requires an understanding of the mechanism of action of these agents and recognition of side effects, especially those important during pregnancy.