Cífková R
Pracoviste preventivní kardiologie IKEM, Praha.
Vnitr Lek. 2006 Mar;52(3):263-70.
Hypertension in pregnancy is one of the main causes of maternal, fetal and newborn morbidity and mortality in civilised countries. Current recommendations of the European Society for Hypertension prefer definition of hypertension in pregnancy based on absolute values of blood pressure, i.e. systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg. The most important task of classification of hypertension in pregnancy is to distinguish whether hypertension comes before pregnancy (the so called pre-existing hypertension) or whether it is a pregnancy-induced condition (the so called gestational hypertension). Pre-existing hypertension is diagnosed either before pregnancy or within the first 20 weeks of pregnancy. Gestational hypertension is characterised with poor blood circulation in many body organs, higher value of blood pressure usually being just one of the characteristic features. Non-pharmacological treatment of hypertension must be considered in pregnant women with systolic blood pressure 140-150 mm Hg or diastolic blood pressure 90-99 mm Hg. Salt restriction is not recommended, as well as weight reduction in obese women. Systolic blood pressure > or = 170 mm Hg or diastolic blood pressure > or = 110 mm Hg in pregnant women must be considered serious condition necessitating hospitalisation. Pharmacological therapy should include labetalol i.v. or metyldopa or nifedipin administered orally. Intravenous administration of dihydralazine is no longer a therapy of choice, for its use is connected with increased occurrence of adverse effects. The threshold values for commencement of anti-hypertension therapy are systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg in females with gestational hypertension without proteinuria or with pre-existing hypertension before commencement of 28th week of pregnancy. Drug administration to reduce hypertension is instituted after reaching the same threshold values in females with gestational hypertension and proteinuria or after occurrence of the symptoms any time during pregnancy, with the same threshold values of blood pressure in the case of pre-existing hypertension at the presence of accompanying diseases or organ malfunction and further in the case of pre-existing hypertension and gestational hypertension. In other cases drug treatment of hypertension is recommended at systolic blood pressure values of 150 mm Hg or diastolic blood pressure values of 95 mm Hg. Unless serious hypertension is involved, the drugs of choice include metyldope, labetalol, calcium channel blockers and beta-blockers. Calcium channel blockers are considered safe, unless administered concurrently with magnesium sulphate (risk of hypotension in the case of potential synergism). ACE inhibitors and angiotensine blockers II (AT1-blockers) are contraindicated in pregnancy. Treatment with diuretics is not substantiated, unless oliguria is present. I.v. magnesium sulphate is recommended for prevention of eclampsia and spasm treatment.
妊娠高血压是文明国家孕产妇、胎儿及新生儿发病和死亡的主要原因之一。欧洲高血压学会目前的建议倾向于根据血压绝对值来定义妊娠高血压，即收缩压≥140 mmHg或舒张压≥90 mmHg。妊娠高血压分类的最重要任务是区分高血压是孕前就存在（所谓的孕前高血压）还是妊娠诱发的情况（所谓的妊娠期高血压）。孕前高血压在妊娠前或妊娠的前20周内被诊断出来。妊娠期高血压的特点是许多身体器官血液循环不良，血压升高通常只是其特征之一。收缩压在140 - 150 mmHg或舒张压在90 - 99 mmHg的孕妇必须考虑进行高血压的非药物治疗。不建议限制盐摄入，肥胖女性也不建议减重。孕妇收缩压≥170 mmHg或舒张压≥110 mmHg必须被视为严重情况，需要住院治疗。药物治疗应包括静脉注射拉贝洛尔或口服甲基多巴或硝苯地平。静脉注射肼屈嗪不再是首选治疗方法，因为其使用会增加不良反应的发生率。对于无蛋白尿的妊娠期高血压女性或妊娠28周前就存在孕前高血压的女性，抗高血压治疗开始的阈值是收缩压140 mmHg或舒张压90 mmHg。对于有蛋白尿的妊娠期高血压女性，在达到相同阈值或孕期任何时候出现症状时开始使用降低血压的药物，对于伴有其他疾病或器官功能障碍的孕前高血压患者以及孕前高血压合并妊娠期高血压的情况，血压阈值相同。在其他情况下，收缩压值为150 mmHg或舒张压值为95 mmHg时建议进行高血压药物治疗。除非涉及严重高血压，否则首选药物包括甲基多巴、拉贝洛尔、钙通道阻滞剂和β受体阻滞剂。钙通道阻滞剂被认为是安全的，除非与硫酸镁同时使用（可能存在协同作用时会有低血压风险）。血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体阻滞剂（AT1受体阻滞剂）在妊娠期间禁用。除非存在少尿，否则利尿剂治疗没有依据。建议静脉注射硫酸镁预防子痫和治疗痉挛。
