고혈압은 임신 전에 조절하셔야 합니다. 정상 혈압 또는 약간의 혈압 상승만으로 말초기관 손상이 없는 고혈압 환자(여성)는 약물을 중단하고 면밀한 모니터링을 하며, 만약 혈압이 상승하면 다시 재투약할 수도 있습니다. ACEI, ARB와 같은 약제를 복용 중이라면 임신 중 복용을 피해야 하며 이 약제는 임신 중 어느 단계에서나 태아에 이상효과를 나타낼 수 있습니다. 만약 이 약제를 복용 중이라면 다른 약제로 변경해야 합니다. 장시간 고혈압이나 조절하지 못한 고혈압을 앓는 환자는 말초기관에 대한 평가를 받아야 합니다.
Blood pressure manageme nt – For patients who have achieved stable blood pressure control with pharmacotherapy and are considering pregnancy or attempting to conceive, the risks and benefits of continuing a stable antihypertensive drug regimen versus changing the regimen to the few drugs preferred for use in pregnant patients (labetalol, nifedipine, methyldopa) must be considered. We suggest shared decision-making involving the obstetrician/maternal-fetal medicine specialist, primary care provider, and patient. However, angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be discontinued before pregnancy since they have been associated with fetal malformations, including renal dysgenesis and calvarial hypoplasia, as well as fetal growth restriction and oligohydramnios .
In patients who have not achieved stable blood pressure control, blood pressure should be optimized with similar considerations about choice of drug therapy as described above.Patients not on antihypertensive therapy and without end-organ disease – For women with nonsevere hypertension (systolic blood pressure ≥140 and <160 mmHg or diastolic blood pressure ≥90 and <110 mmHg) who are not on antihypertensive therapy and have no end – organ involvement , we generally initiate this therapy when blood pressures approach the severe range in order to prevent development of severe maternal hypertension while minimizing fetal exposure .
After initiation of therapy , target blood pressure continues to be an area of controversy . Our target blood pressure range is 120 to 150 / 80 to 95 mmHg ; a target range of 130 to 150 / 80 to 100 mmHg is also common . We use the fewest medications at the lowest effective dose to achieve this goal . REF . UpToDate 2021 . 07 . 09