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Counsel on Increased Risk with Pregnancy
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Management
- Prior to conception, evaluate and treat hypertension. Perform baseline renal function testing. If suspect end organ damage, consider need for ECG and echocardiogram.
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Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are known human teratogens that cause abnormal development, growth restriction, oligohydramnios, fetal death, and neonatal renal failure.
- If hypertension can be successfully managed with another medication, avoid ACE inhibitors and ARBs during pregnancy, and switch women anticipating pregnancy to an alternative antihypertensive agent before conception.
- When ACE inhibitors and ARBs are unavoidable, counsel the patient about the importance of effective contraception, emphasizing that long-acting reversible contraception is most effective for preventing pregnancy.
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Oral antihypertensives used to manage chronic hypertension during pregnancy:
- Labetalol
- Nifedipine
- Methyldopa
- Oral antihypertensives used as adjunctive therapies include thiazide diuretics and hydralazine.
- Discuss body mass index (BMI), smoking and alcohol use with women who have chronic hypertension. Include discussions about healthy diet and exercise.
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