Naden R P, Redman C W
Clin Perinatol. 1985 Oct;12(3):521-38.
When mean arterial pressure exceeds 140 mmHg (equivalent to 180/120), there is a significant risk of maternal cerebral vascular damage. Therefore it is recommended that blood pressures greater than 170/110 should be treated with urgency, aiming to maintain the blood pressure at all times at less than 170/110 but not lower than 130/90. Parenteral hydralazine is effective and safe therapy. Labetalol (intravenously or orally) appears to be as effective and as safe, and causes fewer troublesome side effects; however, clinical experience of its use is more limited, particularly in relation to its safety for the fetus and neonate. Delivery of the fetus is usually the definitive management of severe hypertension in pregnancy. However, this action may not reduce the blood pressure immediately. After initial treatment with rapid-acting agents, it is often advantageous to maintain control of arterial pressure with ongoing oral therapy (methyldopa, labetalol). In addition to the protective effect on the mother, such therapy may allow delivery of the fetus to be deferred; this should be considered only if the fetus is significantly premature (e.g., less than 34 weeks), there is no other evidence of maternal or fetal distress, and there can be meticulous monitoring of the maternal and fetal state proceeding to prompt delivery if deterioration occurs. The indications for treatment of mild or moderate hypertension in pregnancy are less clear. Severe hypertensive episodes can be reduced by several drugs (methyldopa, labetalol, beta-blockers). Methyldopa appears to reduce the small risk of mid-trimester abortions seen in association with early hypertension. Other benefits may be possible with other individual drugs; however, none of these have been found consistently in controlled studies to date. There seems, therefore, to be no definite indication for treatment of mild hypertension in pregnancy; treatment of moderate hypertension may be reasonable but its value is unproved at present. Antihypertensive drugs are valuable in pregnancy to reduce the risks directly due to elevated blood pressure. These drugs are not expected to affect the evolution of preeclampsia nor to treat the other complications of this condition.
当平均动脉压超过140 mmHg（相当于180/120）时，孕产妇发生脑血管损伤的风险显著增加。因此，建议对血压高于170/110的情况进行紧急治疗，目标是始终将血压维持在170/110以下，但不低于130/90。胃肠外使用肼屈嗪是一种有效且安全的治疗方法。拉贝洛尔（静脉注射或口服）似乎同样有效且安全，且副作用较少；然而，其使用的临床经验更为有限，尤其是在其对胎儿和新生儿的安全性方面。分娩胎儿通常是妊娠期重度高血压的最终治疗方法。然而，这一行动可能不会立即降低血压。在用速效药物进行初始治疗后，采用持续口服疗法（甲基多巴、拉贝洛尔）维持动脉压控制通常是有益的。除了对母亲有保护作用外，这种疗法还可能使胎儿分娩推迟；只有在胎儿明显早产（如小于34周）、没有其他母婴窘迫证据且能够对母婴状态进行细致监测并在病情恶化时迅速分娩的情况下，才应考虑这样做。妊娠期轻度或中度高血压的治疗指征尚不清楚。几种药物（甲基多巴、拉贝洛尔、β受体阻滞剂）可减少重度高血压发作。甲基多巴似乎可降低与早期高血压相关的孕中期流产的小风险。其他个别药物可能还有其他益处；然而，迄今为止在对照研究中尚未一致发现这些益处。因此，似乎没有明确的指征对妊娠期轻度高血压进行治疗；治疗中度高血压可能是合理的，但目前其价值尚未得到证实。抗高血压药物在妊娠期对于降低直接由血压升高导致的风险很有价值。预计这些药物不会影响子痫前期的发展，也不会治疗该病症的其他并发症。
