Abstract
This report updates the 1990 “National High Blood Pressure Education Program Working
Group Report on High Blood Pressure in Pregnancy” and focuses on classification, pathophysiologic
features, and management of the hypertensive disorders of pregnancy. Through a combination
of evidence-based medicine and consensus this report updates contemporary approaches
to hypertension control during pregnancy by expanding on recommendations made in “The
Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure.” The recommendations to use Korotkoff phase
V for determination of diastolic pressure and to eliminate edema as a criterion for
diagnosing preeclampsia are discussed. In addition, the use as a diagnostic criterion
of blood pressure increases of 30 mm Hg systolic or 15 mm Hg diastolic with blood
pressure <140/90 mm Hg has not been recommended, because available evidence shows
that women with blood pressures fitting this description are not more likely to have
adverse outcomes. Management distinctions are made between chronic hypertension that
is present before pregnancy and hypertension that occurs as part of the pregnancy-specific
condition of preeclampsia, as well as management considerations for women with comorbid
conditions. A discussion of the pharmacologic treatment of hypertension during pregnancy
includes recommendations for specific agents. The use of low-dose aspirin, calcium,
or other dietary supplements in the prevention of preeclampsia is described, and expanded
sections on counseling women for future pregnancies and recommendations for future
research are included. (Am J Obstet Gynecol 2000;183:S1-S22.)
Keywords
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Article info
Footnotes
☆This work was supported by the National Heart, Lung, and Blood Institute.
☆☆Approved by the National High Blood Pressure Education Program Coordinating Committee, January 21, 2000.
★Reprint requests: Edward J. Roccella, PhD, MPH, National Heart, Lung, and Blood Institute, 31 Center Dr, MSC 2480, Bethesda, MD 20892.
★★*See Appendix at end of article for list of working group members and member organizations.
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© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
