AHA Releases New Statement on Diagnosing, Managing Hypertensive Disorders of Pregnancy

Vesna D. Garovic, MD, PhD

The American Heart Association (AHA) has released a new scientific statement aimed at addressing diagnosis, treatment goals, and pharmacotherapy for hypertension during pregnancy.

Released on December 15, the 21-page document was prepared by a volunteer writing group on behalf of the AHA’s Council on Hypertension, Council on the Kidney in Cardiovascular Disease Science Subcommittee, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Lifestyle and Cardiometabolic Health, Council on Peripheral Vascular Disease, and the Stroke Council.

“For decades, the benefits of blood pressure treatment for pregnant women were unclear. And there were concerns about fetal well-being from exposure to antihypertensive medications,” said Chair of the statement writing group Vesna D. Garovic, MD, PhD, chair of the division of nephrology and hypertension with a joint appointment in the department of obstetrics and gynecology at Mayo Clinic in Minnesota, in a statement from the AHA. “Through our comprehensive review of the existing literature, it is reassuring to see emerging evidence that treating high blood pressure during pregnancy is safe and effective and may be beneficial at lower thresholds than previously thought. Now, we have the current statement focused on hypertension during pregnancy to help inform optimal treatment and future research.”

Composed by Garovic and team of 8 colleagues from multiple US-based institutions, the statement’s writing team contained experts representing obstetrics and gynecology, maternal-fetal medicine, cardiology, nephrology, hypertension, and internal medicine. In the opening portion of the statement, the authors noted the timeliness of the statement given current trends in prevalence of hypertensive disorders of pregnancy (HDP) and the potential influence on long-term cardiovascular health.

Using data from a review of evidence published through August 31, 2020, the statement cites more than 200 references and is broken down into sections addressing epidemiology, prevention of preeclampsia and adverse maternal and fetal outcomes, blood pressure measurement in pregnancy, treatment of hypertension in pregnancy, postpartum screenings, importance of a multidisciplinary team approach, and racial disparities.

The document also includes 4 tables outlining the risks of immediate maternal and fetal complications of HDP, long-term maternal and offspring complications of HDP, risk factors for preeclampsia, and a summary of previously published guidelines for diagnosis and treatment of HDP. Statement authors highlighted the importance of individualizing treatment decisions through team-based care due to the complex nature of managing HDP.

“Future clinical trials are needed to address questions about when to begin treatment for high blood pressure during pregnancy,” Garovic said. “Also, close collaboration between the American Heart Association and American College of Obstetricians and Gynecologists will be instrumental in optimizing diagnosis and treatment of hypertension during pregnancy and in improving immediate and long-term outcomes for many women who develop hypertension during pregnancy.”

This statement, “Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy,” was published in Hypertension.