Acute Hypertensive Definitions in the Pregnant Patient

Hypertensive disorders are common during pregnancy and can be classified into four pregnancy-associated categories: (1) chronic hypertension, (2) gestational hypertension, (3) preeclampsia, and (4) chronic hypertension with superimposed preeclampsia. In addition, non-pregnancy associated hypertensive emergencies can occur in the pregnant patient.

Acute Hypertensive Definitions in the Pregnant Patient

Name BP Criteria Additional Criteria
“Severe” acute
hypertension
SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg
Preeclampsia SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg BP readings must occur on ≥ 2 occasions, ≥ 4 hr apart, > 20 weeks gestation
Either:
• Proteinuria (24 hr urine collection ≥ 300 mg protein
OR spot urine collection Uprotein/UCr ≥ 0.3 mg/dL)
• Severe featuresa
Eclampsia Preeclampsia degree of BP elevation New-onset grand mal seizures in a woman with no known seizure disorder
HELLP syndrome With or without preeclampsia degree of BP elevation Evidence of the following:
• Hemolysis (schistocytes on peripheral smear, increased LDH,
decreased haptoglobin, increased Tbili [≥ 1.2 mg/dL], decreased haematocrit)
• Elevated liver enzymes (AST/ALT (≥ 70 IU/L)
• Low Platelet (< 100,000 mcL)
Hypertensive
emergency
BP ≥ 240/140 mm Hg

 

aSevere features = SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg, Plt < 100,000/mm3, AST/ALT > 2 x ULN, right upper quadrant or epigastric pain unresponsive to medication, cerebral/visual symptoms, renal injury (SCr > 1.1 mg/dL or > 2 x baseline), or pulmonary edema.

Abbreviations: Tbili = total bilirubin; UCr = urinary creatinine; ULN = upper limit of normal; Uprotein = urinary protein; SBP = systolic blood pressure; DBP = diastolic blood pressure.

 

References:

  1. Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med. 2019 Apr 10;7:2050312119843700. [Medline]
  2. Wilkerson RG, Ogunbodede AC. Hypertensive Disorders of Pregnancy. Emerg Med Clin North Am. 2019 May;37(2):301-316. [Medline]

 

Created Nov 21, 2019.

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