High blood pressure treatment deemed safe during pregnancy, AHA says

New clarity around blood pressure treatment during pregnancy has been provided by the American Heart Association (AHA) after years of uncertainty: high blood pressure treatment in pregnant women is considered safe. In addition, such treatment may reduce maternal risk for severe hypertension without increasing fetal and neonatal risks.

The new scientific statement, published in the organization’s journal, Hypertension, says that high blood pressure during pregnancy remains a major cause of maternal and fetal pregnancy-related complications and death, and it increases women’s short-and long-term risks for cardiovascular disease.

According to the statement, the United States has one of the highest hypertensive-related maternal mortality rates. Cardiovascular disease now accounts for up to half of all maternal deaths in the U.S., and pregnancy-related stroke hospitalizations increased more than 60 percent from 1994 to 2011. Preeclampsia affects five percent to seven percent of pregnancies and is responsible for more than 70,000 maternal deaths and 500,000 fetal deaths worldwide every year, according to the AHA.

Statistics from the AHA also indicate hypertension during pregnancy, defined as a systolic pressure of 140 mm Hg or higher, is the second leading cause of maternal death worldwide. Hypertension during pregnancy is on the rise and data shows that it disproportionately impacts women who are from diverse and ethnic backgrounds in the U.S., particularly those who are Black, American Indian, or Alaskan Native.  

“For decades, the benefits of blood pressure treatment for pregnant women were unclear,” said Vesna D. Garovic, MD, PhD, chair of the statement writing group and chair of the division of nephrology and hypertension at Mayo Clinic in Rochester, Minnesota. “Through our comprehensive review of the existing literature, it is reassuring to see emerging evidence that treating high blood pressure during pregnancy is safe and effective and may be beneficial at lower thresholds than previously thought. Now, we have the current statement focused on hypertension during pregnancy to help inform optimal treatment and future research.”

The goals of treatment during pregnancy include preventing severe hypertension and early delivery to allow the fetus time to mature before delivery. Continued research is essential to determine which blood pressure levels, during- and post-pregnancy, both for starting therapy and as treatment goals, are beneficial for the mother and safe for the fetus.

The statement advises multidisciplinary, team-based personalized care where clinicians partner with the patient to determine preferred treatment and consider the risks for hypertension-related adverse outcomes.