Treat sudden jump in systolic blood pressure as emergency in preeclamptic patients

January 1, 2006

Abiding by the old rules and waiting for a severely preeclamptic patient's diastolic blood pressure (BP) to reach or rise above 110 mm Hg before beginning to treat hypertension can invite a deadly stroke, warned a leading Jackson, Miss. maternal-fetal medicine researcher. Instead, consider treating as a hypertensive emergency a pregnant patient's sudden severe systolic BP reading of 155 to 160 mm Hg or more, regardless of the diastolic reading, said James N. Martin, Jr., MD, Professor of Obstetrics and Gynecology, and Director of Maternal-Fetal Medicine and Obstetrics at the University of Mississippi School of Medicine.

Abiding by the old rules and waiting for a severely preeclamptic patient's diastolic blood pressure (BP) to reach or rise above 110 mm Hg before beginning to treat hypertension can invite a deadly stroke, warned a leading Jackson, Miss. maternal-fetal medicine researcher. Instead, consider treating as a hypertensive emergency a pregnant patient's sudden severe systolic BP reading of 155 to 160 mm Hg or more, regardless of the diastolic reading, said James N. Martin, Jr., MD, Professor of Obstetrics and Gynecology, and Director of Maternal-Fetal Medicine and Obstetrics at the University of Mississippi School of Medicine.

In speaking on "Aggressive Management of HELLP Syndrome" (hemolysis, elevated liver enzymes, and low platelet count at the ACOG District II/NY Annual Meeting in New York City, Dr. Martin reiterated his call for a paradigm shift focusing on systolic rather than conventional BPs in women with severe preeclampsia and eclampsia-based on his group's data published earlier this year (Obstet Gynecol. 2005;105:246-256). In contrast, the conventional general recommendation of the American College of Obstetricians and Gynecologists in its most recent practice bulletin (Diagnosis and Management of Preeclampsia and Eclampsia. No. 33, January 2002) is to begin antihypertensive therapy when diastolic BP levels reach 105 to 110 mm and higher.

"This should serve as a wake-up call that an observational study of thousands of women is still needed," Dr. Martin said of his group's earlier findings from a small study of 28 women. The study found that for the pregnant adult who develops acute severe hypertension-especially if she has severe preeclampsia/eclampsia-there seems to be a closer correlation with systolic than diastolic hypertension for risk of hemorrhagic stroke. (Diastolic BP can still be a factor, but a lesser one.)

HELLP syndrome calls for aggressive treatment like BP control and the well-known dexamethasone "rescue therapy" pioneered by Dr. Martin's tertiary care center at UMC, he said, because it's a complex disease process "that has its genesis at the beginning of the pregnancy, but we see it only in the ninth inning."

Martin JN. Aggressive Management of HELLP Syndrome. Presented at ACOG District II/NY Annual Meeting, October 28-30, 2005.