Selecting the appropriate anti hypertensives in pregnancy period?

Life style in Low-risk hypertension

Women with low-risk chronic hypertension without superimposed preec­lampsia usually have a pregnancy outcome similar to that in the general obstetric population. In addition, discontinuation of antihypertensive ther­apy early in pregnancy does not affect the rates of preeclampsia, abruptio  placentae or preterm delivery in these women. My policy is to discontinue antihypertensive treatment at the first prenatal visit because the majority of these women will have good pregnancy outcome without such therapy. Although these women do not require pharmacological therapy, a careful management is still essential At the time of initial and subse­quent visits, the patient is educated about nutritional requirements, weight gain and sodium intake (maximum of 2.4 g of sodium per day). During each subsequent visit they are observed very closely

Who are high risk HTN not for us?? High-risk hypertension

Women with high-risk chronic hypertension are at increased risk for adverse maternal and perinatal complications. Women with significant renal insufficiency (serum creatinine >1.4mg/dL), diabetes mellitus with vascular involvement severe collagen vascular disease, cardio­myopathy or coarctation of the aorta should receive thorough counseling regarding the adverse effects of pregnancy before conception. These women should be advised that pregnancy may exacerbate their condition with the potential for congestive heart failure, acute renal failure requiring dialysis, and even death. In addition, perinatal loss and neonatal complications are markedly increased in these women. All such women should be managed by or in consultation with a subspecialist

 in maternal-fetal medicine, as well as in association with other medical specialists as needed.

Women with high-risk hypertension may require hospitalization at the time of first prenatal visit for evaluation of cardiovascular and renal status and for regulation of antihypertensive medications, as well as other prescribed medications Women receiving atenolol, ACE inhibitors or angiotensin II receptor antagonists should have these medications discontinued under close observation.

 Antihypertensive therapy, with one or more of the drugs are subsequently used in all women with severe hypertension. In women without target organ damage, the aim of antihypertensive therapy is to keep systolic blood pressure between 140 and 150 mm  Hg and diastolic blood pressure between