Report of the National High Blood Pressure Education Program Working Groupon High Blood Pressure in Pregnancy

This report updates the 1990 "National High Blood Pressure Education Progra m Working Group Report on High Blood Pressure in Pregnancy" acid focuses on classification, pathophysiologic features, and management of the hypertens ive disorders of pregnancy. Through a combination of evidence-based medicin e and consensus this report updates contemporary approaches to hypertension control during pregnancy by expanding on recommendations made in "The Sixt h Report of the Joint National Committee on Prevention, Detection. Evaluati on. and Treatment of High Blood Pressure." The recommendations to use Korot koff 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 syst olic or 15 mm Hg diastolic with blood pressure <140/90 mm Hg has not been r ecommended, because available evidence shows that women with blood pressure s fitting this description are not more likely to have adverse outcomes. Ma nagement distinctions are made between chronic hypertension that is present before pregnancy and hypertension that occurs as part of the pregnancy-spe cific condition of preeclampsia, as well as management considerations for w omen with comorbid conditions. A discussion of the pharmacologic treatment of hypertension during pregnancy includes recommendations for specific agen ts. The use of low-dose aspirin, calcium, or other dietary supplements in t he prevention of preeclampsia is described, and expanded sections on counse ling women for future pregnancies and recommendations for future research a re included.