Patient's question:
I am 32 weeks pregnant. I found out I had high blood pressure around 20 weeks. Now it's as high as 143/96, and my urine protein test came back positive. I have swelling in my ankles and calves. Is this preeclampsia? Based on my condition, is it mild or moderate preeclampsia? Do I need medication now? Which type of medication has the least side effects on the fetus? Should I take Western medicine or Chinese medicine? Should I wait to be observed until 36 weeks before starting medication?First follow-up question: During my prenatal checkup, the doctor recommended I take Nifedipine to lower my blood pressure. Which category of medication does it belong to? I searched online and found that its side effects are quite significant. Can I take it?
Doctor's answer:
Hello: Gestational hypertension is a common complication in the middle and late stages of pregnancy, which is harmful to both the fetus and the pregnant woman and must be actively treated. Currently, most scholars believe that, for caution, diastolic blood pressure greater than 105 mmHg should be used as the basis for medication to avoid the development of preeclampsia or eclampsia.Regarding the drug selection for gestational hypertension, beta-blockers such as atenolol or metoprolol are the first choice. These antihypertensive drugs pose no significant risks in the later stages of pregnancy and do not affect the fetus, making them relatively safe. Second, calcium channel blockers such as nifedipine and felodipine can also be used, but attention should be paid not to use them in the last half month of pregnancy, as they can inhibit uterine smooth muscle contraction, thereby affecting the smooth progress of labor. The combination of beta-blockers and calcium channel blockers is often misused in moderate gestational hypertension. When used together, the dosages of both types of drugs are relatively small, and the side effects are reduced, making it safer.
If beta-blockers cannot control blood pressure, especially in cases of severe hypertension, methyldopa or hydralazine can be combined. It is generally considered that this combination is relatively safe, with few severe side effects. For pregnant women with preeclampsia or eclampsia, the condition should be treated as a hypertensive emergency, and rapid blood pressure reduction should be initiated. Magnesium sulfate is first used to lower blood pressure. If the effect is unsatisfactory, nitrates can be administered intravenously, such as sodium nitroprusside or nitroglycerin, which are relatively safe. For the blood pressure reduction standard in preeclampsia, it should be rapidly lowered to 160–170/100–110 mmHg, and then oral antihypertensive drugs should be used to continue reducing blood pressure to a satisfactory level.
Points to note: Angiotensin-converting enzyme inhibitors (ACEIs), ganglionic blockers, guanethidine, and reserpine