Veronika Pokorná, Terézia Pázmanová
Hypertension in pregnancy complicates up to 15% of pregnancies and is the main reason of maternal, foetal and neonatal
morbidity and mortality. Definition of hypertension in pregnancy is based on absolute values of blood pressure
(systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg). There are 4 types of hypertension in pregnancy, namely pre-existing
hypertension, gestational hypertension, pre-existing hypertension with superimposed gestational hypertension with
proteinuria, and antenatally unclassifiable hypertension. According to absolute BP values, there are 2 types of hypertension
in pregnancy – mild (140-159/90-109 mmHg) and severe (≥ 160/110 mmHg) hypertension. Preeclampsia is gestational
hypertension with proteinuria > 0,3 g/ 24h; in case of seizures, the term eclampsia is used. Severe complications
of preeclampsia include neurological manifestations, renal and hepatic failure, HELLP syndrome. The only causal
treatment of preeclampsia is birth of placenta. Neither weight reduction nor salt restriction are recommended. Calcium
supplementation should be considered. Pharmacological treatment of hypertension in pregnancy represents a severe
medical problem, as the safety of antihypertensive drugs cannot be tested in pregnancy for ethical reasons. The
recommendations on treatment are therefore based on expert consensus. Methyldopa is the only drug with sufficiently
proven safety. Gestational hypertension usually recurs in subsequent pregnancies; low dosed acetylsalicylic acid is
used prophylactically. Women who suffered from gestational hypertension are at a higher cardiovascular risk and require
regular monitoring.