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Hypertension – Hypertension in Pregnancy

Hypertension is a chronic disease characterized by the continuous pressure exerted by the blood against the arterial walls.

Arterial Tension [T.A] is regulated by “Cardiac Expense”, “Blood Volume” and “Peripheral Resistance”:

Cardiac Expenditure: It is the frequency and strength of the contraction.
Blood volume: volume of fluid contained in the arteries.
Peripheral resistance: Constriction and dilatation of blood vessels.

Determinants of Hypertension

Family history because this condition can be inherited

Tobacco smoking for two reasons, FIRST because tobacco increases the permeability of the endothelium, which causes the filtration of lipids in the vascular walls and SECOND because with tobacco they increase the Adrenaline, Noradrenaline and Dopamine (catecholamines) that increase the contractility of the myocardium and the vasoconstriction (peripheral resistance).
Hypertension in Pregnancy
Sedentary because it leads to obesity

Obesity because it increases the concentrations of lipids in the blood, with risk of producing atherosclerosis. Every 10 kg of weight loss decreases blood pressure between 5 and 20 mmHg.

Poor nutrition due to excess salt and fats.

Diabetes due to vasculopathy that degenerates into atherosclerosis.

Being an older adult because at that age increases the chances of hypofunction of the regulatory system of cardiac output and peripheral resistance.

Hypertensive Urgency

Hypertensive emergencies occur in patients with a hypertensive peak, maximum pressure above 180 mmHg or a minimum above 110 mmHg, however, without relevant symptoms or signs of acute injury to any target organ (eyes, heart, brain and kidneys). Generally it does not cause risk of death.

Hypertensive emergency can be reduced in hours or days. In elderly patients, abrupt falls in blood pressure may trigger myocardial infarction or stroke.

Medication for hypertensive peaks

– Captopril.
– Clonidine.
– Furosemide, in case of lower limb edema or heart failure
– Diazepam, if the patient is very anxious
– Sublingual Nifedipine (Adalat) with caution because it abruptly lowers the tension.
– Nifedipine retard (Adalat is slow-release and does not cause a sudden drop in pressure.

It is the Hypertension that appears in Pregnancy and can be classified into four types:

– Hypertension induced by pregnancy

– Chronic hypertension

– Chronic hypertension with superimposed preclampsia

– Transient hypertension.

Classification

A. Hypertension induced by pregnancy is that maternal hypertension that develops a preclampsia or eclampsia.

PRECLAMPSIA is a hypertension with the following Signs and Symptoms:
– Arterial hypertension
– Proteinuria, at week 20 of pregnancy
– Sudden weight gain, due to water accumulation in tissues
– Edema on the face, hands and feet
– Headache
– Early symptoms due to “Mola Hidatiforme” (tumor in the placenta, with or without the fetus).

Potential problems:
– Cerebral haemorrhage
– HELLP (Anemia + Liver enzymes + Thrombocytopenia)
– Pulmonary edema, Cyanosis

ECLAMPSIA is a Preclam with the following Signs and Symptoms:
– Fast and alternating muscle contractions
– Seizures due to cerebral vasospasm (in prepartum, parturition or postpartum, up to 48 hours later)
– Congested face and injected eyes
– Foam by the mouth
– Eat from minutes to hours
– T.A from 180 to 200 mmHg.

Potential problems:
– Eat deep
– Anuria
– Fever with rapid pulse
– Pulmonary edema with vascular collapse

B. Chronic Hypertension is one in which the mother was already hypertensive.
– T.A = 140/90 before 20 weeks of gestation
– T.A = 140/90 after childbirth indefinitely
– Plasmatic urea nitrogen 20 mg / dl.
– Plasma creatinine 1mg / dl.
– Presence of Diabetes or diseases of the connective tissues.
– Hemorrhagia and exudates in the background examination

C. Chronic Hypertension with Superimposed Preclampsia is one that does not disappear after pregnancy:
– Before the 30th week of pregnancy
– Chronic hypertension
– High systolic and diastolic pressure at 6-hour intervals
– Proteinuria
– Edemas

D. Transient Hypertension is one in which there is no edema or proteinuria, only:
– Hypertension in childbirth and postpartum
– Normalized arterial tension, 10 days after delivery

Hypertension Care in Pregnancy
Use Anticonvulsant Magnesium Sulfate (MgSO4), except in bradypnea with hypotension
CSV every 15-30 min when using MgSO4 (antidote: Calcium Gluconate 10%)
Pulmonary auscultation, to prevent acute pulmonary edema.
Control of strict income and expenses. Diuresis 30 ml / hour.
Rate Glasgow Scale: drowsiness, lethargy, inappropriate speech.
Have ready May Cannula, Oxygen Mask
Hypercaloric diet.
Rate Tendinous Reflexes: 0: Absent reflex, 1: Hypoactive reflex, 2: Normal reflex, 3: Hyperctive reflex, 4: Clone reflex

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