Pharmacological treatment of severe hypertension in pregnancy and the roleof serotonin(2)-receptor blockers

Hypertensive disorders of pregnancy are the leading cause of maternal and p erinatal mortality and morbidity in developing and developed countries. The etiology of preeclampsia is still unknown. Delivering the baby is the only definite treatment. The benefits of acute pharmacological control of sever e hypertension prior to and/or post-delivery are generally accepted. Most d rugs commonly used in the management of severe hypertension in pregnancy ha ve significant maternal and/or neonatal adverse side effects. Furthermore, some are not effective to acutely lower the blood pressure in patients with a hypertensive crisis. Until recently not one of the commonly used antihyp ertensive drugs has been tailored to the pathophysiology of severe preeclam psia, being a clinical syndrome characterized by endothelial cell dysfuncti on, vasospasm and platelet aggregation. Ketanserin, a serotonin(2)-receptor blocker, is a drug that appears to be t ailored for treating this pregnancy-associated enthothelial cell dysfunctio n. The results of several prospective trials show that there is a definite place for serotonin(2)-receptor blockers in the treatment of pregnancy-indu ced hypertensive disorders. This review provides a summary on the more established drugs as well as on some of the newer antihypertensive drugs used in pregnancy with emphasis on the existing experience with ketanserin. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.