THE PHARMACOLOGICAL MANAGEMENT OF HYPERTENSION IN PREGNANCY

Purpose: The management of pregnancy-induced hypertension (PIH) and pr eeclampsia using antihypertensive drug therapy remains contentious. Co nflicts arise due to differences in diagnostic criteria and varying at titudes regarding the value of treating hypertension, which is only on e aspect of this systemic disorder. The following review assesses the role of individual agents and their effects upon both maternal and foe tal/neonatal wellbeing. Study selection: Human clinical trials of each of the main antihypertensive drugs used in the management of PIH/pree clampsia are reviewed. The value of randomized, placebo-controlled tri als and long-term paediatric follow up is stressed. Results of data an alysis: A number of agents have a favourable benefit-risk profile for use in women with PIH/preeclampsia; these include alpha-methyldopa, be ta-blockers, hydralazine, prazosin, calcium channel antagonists and ke tanserin. Diazoxide and sodium nitroprusside may also be used for acut e severe hypertension. Angiotensin converting enzyme inhibitors are co ntra-indicated. Low-dose aspirin is presently being investigated in mu lticentre trials and may play a major role in the prevention of preecl ampsia. Conclusion: Decisions regarding the need for antihypertensive treatment during pregnancy and the selection of a specific antihyperte nsive agent should be based upon an assessment of the relative benefit s and risks for the individual patient. In future studies, the effects of antihypertensive agents upon the underlying pathophysiological pro cesses involved in PIH/preeclampsia may guide therapeutic decision mak ing.