Gestational & Chronic Hypertension in Pregnancy

Gestational and chronic hypertension in pregnancy are the two forms of high blood pressure, 140/90 or higher, that are sorted by when they start: chronic hypertension is present before pregnancy or diagnosed before 20 weeks, and gestational hypertension is new at or after 20 weeks without proteinuria or other preeclampsia signs. Gestational hypertension is confirmed by two readings at least four hours apart. Either type can progress to preeclampsia, so the nurse watches for new proteinuria and warning signs such as a severe headache that won't go away, vision changes, upper-abdominal pain, sudden swelling of the face or hands, and trouble breathing. A reading of 160 systolic or 110 diastolic or higher that lasts 15 minutes needs IV labetalol, IV hydralazine or immediate-release oral nifedipine within 30 to 60 minutes. Labetalol, extended-release nifedipine and methyldopa are the oral medicines used in pregnancy, while ACE inhibitors and ARBs are contraindicated because they injure the fetal kidneys. Accurate measurement with the right cuff, home monitoring, low-dose aspirin for chronic hypertension and fetal growth checks round out care.