Treatment of severe persistent hypertension

July 27, 2019

Charlene H. Collier, MD, MPH, MHS, FACOG

Dr. Collier is the Director of the Mississippi Perinatal Quality Collaborative (MSPQC) and Maternal Mortality Review Committee (MMRC) at the Mississippi State Department of Health and Assistant Professor Obstetrics & Gynecology at The University of Missis

, James N. Martin Jr., MD, FACOG, FRCOG, FAHA

James N. Martin Jr., MD, FACOG, FRCOG, FAHA

Dr. Martin is Chair of the ACOG Pregnancy and Heart Disease Task Force and Professor Emeritus of Obstetrics, Gynecology & Maternal-Fetal Medicine at The University of Mississippi Medical Center, Jackson.

Emergent treatment of severe acute-onset persistent hypertension constitutes an important component of high-quality obstetric care.

Emergent treatment of severe acute-onset persistent hypertension (systolic BP > 160 mmHg or diastolic BP > 110 mmHg sustained > 15 minutes) constitutes an important component of high-quality obstetric care. Even in the absence of proteinuria, sudden development of sustained severe hypertension causes significant risk of hemorrhagic stroke and death. An estimated 25% to 45% of maternal strokes occur among patients with preeclampsia, eclampsia or HELLP syndrome.¹ Severe systolic blood pressure is a consistent feature present before the onset of stroke in over 90% of women with hypertensive disorders.²

References:

Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke. 2000;31(6):1274-1282.

Martin JN, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105(2):246-254.