Antihypertensive drug therapy for mild-to-moderate hypertension during pregnancy
RHL practical aspects by Lubano K, Qureshi Z
FIRST CONTACT (PRIMARY CARE) LEVEL
Assess all pregnant women in accordance with standardized evidence-based protocols to ensure focused and appropriate antenatal care, which should include:
- identification of any abnormal medical or obstetric conditions;
- measurement of blood pressure;
- in cases of mild-to-moderate hypertension, discussion with the woman to decide on treatment options, and when both the service provider and the woman agree, prescription of antihypertensive drugs as appropriate;
- scheduling of follow-up visits.
Refer complicated cases of hypertension to a higher level of care.
Ensure that equipment to measure blood pressure and adequate quantities of appropriate antihypertensive drugs are available. Ensure also that appropriate staff are available with up-to-date knowledge, skills and attitudes for dealing with pregnant women.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
- All of the above recommendations are also applicable at this level. In addition, health-care workers should implement locally adapted evidence-based clinical practice guidelines that define standards of care for each condition.
- Support and offer oversight to the primary level health-care facilities within their catchments area.
- Offer basic specialized services to individual women referred from the primary level of care as per standard protocols for hypertensive disease; Refer women with complications of hypertensive disease to the tertiary level.
AT HOME OR IN THE COMMUNITY
Raise community awareness about the danger signs of hypertension during pregnancy – such as severe headaches, blurring of vision, severe epigastric pain – to ensure that women seek treatment early.
This document should be cited as: Lubano K, Qureshi Z.Antihypertensive drug therapy for mild-to-moderate hypertension during pregnancy: RHL practical aspects (last revised: 8 October 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.