TY - JOUR
T1 - Hypertension in Pregnancy
T2 - What We Now Know
AU - Gupta, Sonali
AU - Petras, Lohana
AU - Tufail, Muhammad Umer
AU - Rodriguez Salazar, Juan Diego
AU - Jim, Belinda
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Purpose of reviewHypertensive disorders of pregnancy remain a highly morbid condition that affects both the mother and fetus, complicate approximately 10% of pregnancies worldwide, and contribute to immediate and long-term cardiovascular outcomes. There is still much to learn regarding pathogenesis and treatment goals.Recent findingsThere is updated information on the pathogenesis of preeclampsia and treatment thresholds for HTN in pregnancy. l-Kynurenine, a metabolite of the essential amino acid l-tryptophan, has been implicated in preeclampsia as decreased levels were found in a uninephrectomized pregnant mouse model of preeclampsia, where replacement of l-kynurenine rescued the preeclamptic state. Further, data from CHIPS (The Control of HTN in Pregnancy Study) and CHAP (Chronic HTN and Pregnancy) trials demonstrate not only the safety of lowering blood pressure to either a diastolic goal of 85 mmHg (CHIPS) or less than 160/105 mmHg (CHAP) without detriment to the fetus but the CHAPS trial has also shown a decrease in the rate of preeclampsia in the treatment group.SummaryWe will summarize the different types of hypertensive disorders in pregnancy, updates on the pathogenesis of preeclampsia, and appropriate HTN management based on the latest evidence in order to better care for mother and child.
AB - Purpose of reviewHypertensive disorders of pregnancy remain a highly morbid condition that affects both the mother and fetus, complicate approximately 10% of pregnancies worldwide, and contribute to immediate and long-term cardiovascular outcomes. There is still much to learn regarding pathogenesis and treatment goals.Recent findingsThere is updated information on the pathogenesis of preeclampsia and treatment thresholds for HTN in pregnancy. l-Kynurenine, a metabolite of the essential amino acid l-tryptophan, has been implicated in preeclampsia as decreased levels were found in a uninephrectomized pregnant mouse model of preeclampsia, where replacement of l-kynurenine rescued the preeclamptic state. Further, data from CHIPS (The Control of HTN in Pregnancy Study) and CHAP (Chronic HTN and Pregnancy) trials demonstrate not only the safety of lowering blood pressure to either a diastolic goal of 85 mmHg (CHIPS) or less than 160/105 mmHg (CHAP) without detriment to the fetus but the CHAPS trial has also shown a decrease in the rate of preeclampsia in the treatment group.SummaryWe will summarize the different types of hypertensive disorders in pregnancy, updates on the pathogenesis of preeclampsia, and appropriate HTN management based on the latest evidence in order to better care for mother and child.
KW - Chronic HTN and Pregnancy
KW - The Control of HTN in Pregnancy Study
KW - hypertension
KW - preeclampsia
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85146627867&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85146627867&partnerID=8YFLogxK
U2 - 10.1097/MNH.0000000000000857
DO - 10.1097/MNH.0000000000000857
M3 - Review article
C2 - 36683540
AN - SCOPUS:85146627867
SN - 1062-4821
VL - 32
SP - 153
EP - 164
JO - Current opinion in nephrology and hypertension
JF - Current opinion in nephrology and hypertension
IS - 2
ER -