Therapeutic Targets
The goal of drug therapy is to normalize blood pressure levels and thus prevent complications (esp. eclampsia, cerebral hemorrhage, cardiovascular renal and pulmonary failure). It is reserved for severe forms of progression and should be performed exclusively under inpatient conditions. The current S2k guideline recommends lowering blood pressure only at values from 150-160/100-110 mmHg. Therapy aims to reduce maternal complications, for which systolic blood pressure is considered the best predictor. In a study, a strict blood pressure setting was compared with a less strict setting with a target diastolic pressure of 85 mmHg and 100 mmHg. No evidence of fetal retardation (growth retardation during pregnancy) occurred with more stringent blood pressure settings. The authors point out that blood pressure lowering to 85 mmHg diastolic is allowed as long as no maternal complications occur.The current S2k guideline requires that the diastolic blood pressure should not fall below 80 mmHg [“start low”(starting dose and “go slow” (repeat)]. Target blood pressure values should be between 130-150 mmHg systolic and 80-100 mmHg diastolic. See also “Further therapy” indications for hospitalization!
Therapy recommendations
- Long-term therapy of pregnancy-related hypertension (high blood pressure) using alpha-methyldopa Note: Dihydralazine is no longer recommended because of pronounced maternal side effects
- Emergency therapy of pregnancy-induced hypertension, so-called acute therapy; treatment with: Urapidil, nifedipine (both drugs off-label use: use outside the indications or the group of people for which the drugs are approved by drug authorities).
- Therapy for eclampsia/eclampsia prophylaxis: magnesium sulfate, i.v. (first-line agent)
- Drug thromboprophylaxis (therapeutic measures to prevent thrombosis) should be given to all women after preeclampsia, taking into account the individual risk of bleeding.
- Postpartum (after delivery) blood pressure monitoring should be performed for at least 12 weeks in preeclampsia. In the hospital, this should be performed ≥ 4 times per day.
- HELLP syndrome: There is currently no evidence to support the benefit of corticosteroid administration for treatment in HELLP syndrome and preeclampsia.
- See also under “Other Therapy.”
Agents (main indication) in long-term therapy, oral, of pregnancy-related hypertension
Antisympathicotonics
| Active ingredients | Special features |
| Alpha-methyldopa | First-line agent!AI in liver disease, severe renal insufficiency. |
ß1-selective beta-blockers.
| Agents | Special features |
| Metoprolol | Limited suitabilityDose adjustment in severe hepatic insufficiency. |
Calcium antagonists
| Active ingredients | Special features |
| Nifedipine retard | Dose adjustment for hepatic insufficiencyKI for CHD. |
Vasodilators
Dihydralazine, used relatively frequently in the past, is no longer recommended because of marked maternal side effects (orthostatic dysregulation, headache, reflex tachycardia, tachyphylaxis, water retention)).
Agents (main indication) in the emergency therapy of pregnancy-induced hypertension, so-called acute therapy
Antisympathicotonics
| Active ingredients | Special features |
| Urapidil | Dose adjustment in severe renal/hepatic insufficiency. |
Calcium antagonists
| Active ingredients | Special features |
| Nifedipine | Dose adjustment for hepatic insufficiencyKI for CHD. |
Vasodilators
| Active ingredients | Special features |
| Dihydralazine |
Note: onset of action after 3 to 5 minutes, sometimes only after 20 minutes (esp. with bolus administration (and then often overshooting)).
If applicable.Dose adjustment in severe renal/hepatic insufficiency. |
Therapy of eclampsia/eclampsia prophylaxis
Minerals/diuretics/vasodilators.
| Drug group | Active ingredients | Special features |
| Minerals | Magnesium sulfate | Agent of first choice |
| Diuretics | Furosemide | |
| Vasodilators | Nitroglycerin |
Prevention
In drug prevention, the administration of 100 mg/d acetylsalicylic acid has been established. It should be taken from 12 to 36 weeks’ gestation.
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Vitamins (vitamin D* /* * (calciferols), pyridoxine* * (vitamin B6, folic acid* ).
- Minerals (calcium* , magnesium* /* * *
- Fatty acids (omega-3 fatty acids* : Eicosapentaeinic acid* (EPA) and Docosahexaenoic acid* (DHA)).
* Prevention* * Risk groups* * * Therapy
Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.
