This protocol applies to pregnant individuals — or those planning pregnancy — with essential hypertension whose blood pressure has escalated to severe range despite being on chronic antihypertensive maintenance therapy.
First-line chronic antihypertensive maintenance therapy with labetalol or extended-release nifedipine — with methyldopa or hydrochlorothiazide as additional agents, and low-dose aspirin starting after 12 weeks to reduce preeclampsia risk — did not achieve the target of BP <140/90 mm Hg.
When blood pressure subsequently rises into severe range (SBP ≥160 mm Hg or DBP ≥110 mm Hg), urgent escalation is indicated.
Urgent antihypertensive treatment is required using rapid-acting agents — parenteral or oral — selected for use in pregnancy, with the aim of achieving fast blood pressure reduction within a defined time window.
Target: BP <160/110 mm Hg within 30–60 minutesThe full agent selection, administration route, and clinical decision sequence are available in the complete protocol.
DOI: 10.1161/CIR.0000000000001356
Pregnant individuals with SBP ≥160 mm Hg or DBP ≥110 mm Hg confirmed on repeat measurement within 15 minutes should receive antihypertensive medication (Table 23) to lower BP to <160/<110 mm Hg within 30 to 60 minutes to prevent adverse events.
For individuals with hypertension who are planning a pregnancy or who become pregnant, labetalol and extended-release nifedipine are preferred agents to treat hypertension and minimize fetal risk.
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