What can pregnant women do for high blood pressure? High blood pressure during pregnancy

High blood pressure in pregnant women is common and, unfortunately, very dangerous. Hypertension in pregnant women in Russian-speaking countries is observed in 5-30% of cases, in Western Europe - about 15%. She creates big problems for both mother and fetus. If you are pregnant and measurements show that your blood pressure is rising, then this problem should be taken as seriously as possible. First of all, assemble a team good doctors who will take care of you. If they offer to go to the hospital in advance, just in case, agree.

At the same time, there is no need to panic. Reducing blood pressure to normal in a pregnant woman is real. Moreover, it may be even easier than you think, and without harm to the pregnancy. First of all, you should try natural treatments, which are described below. They control hypertension without harmful side effects for mother and unborn child. It is highly likely that you will not need strong pills and injections. In case “chemistry” is still needed, we provide the most detailed information about it too.

This article is intended for pregnant women who have high blood pressure and their relatives. I don't want to scare you again. But we need you to fully understand how serious this situation is. Therefore, possible negative outcomes are listed below.

What complications often cause hypertension in pregnant women:

abruption of a normally located placenta, massive bleeding;
violations cerebral circulation in a pregnant woman;
retinal detachment, which leads to blindness;
preeclampsia and eclampsia (convulsions, deadly);
delayed fetal development;
low newborn Apgar score;
asphyxia (suffocation) and fetal death.

Taking a blood pressure pill that is on hand and then continuing to do your business is absolutely not allowed during pregnancy. Because hypertension poses a significant risk to the fetus and to the mother herself. If you choose the wrong pills for blood pressure, it can have a teratogenic effect, that is, disrupt the development of the fetus. Seeing a doctor is absolutely necessary. Moreover, this should be an intelligent doctor, and not the first one you come across. You can even accept it only after he gives the go-ahead. And even more so, any other blood pressure medications.

Arterial hypertension in pregnant women - when is the systolic “upper” pressure? 140 mmHg and/or diastolic “bottom” pressure? 90 mmHg Art. To confirm the diagnosis, you need to take at least 2-3 measurements at intervals of at least 4 hours.

If the systolic “upper” pressure is > 160 mm Hg. and/or diastolic “bottom” pressure > 110 mm Hg. Art., then this is severe hypertension. If the systolic “upper” pressure is 140-159 mm Hg. and/or diastolic “lower” pressure 90-110 mmHg. Art., then the pregnant woman has moderate hypertension. In case of severe hypertension, you should immediately prescribe potent pills that are potentially dangerous to the fetus. If hypertension is moderate and there is no significant risk of complications, then it is recommended to get tested, continue to be observed by doctors, but do not rush to take pills.

Normally, from the first weeks of pregnancy to the end of the first trimester, a woman’s blood pressure decreases. This occurs because vascular tone is significantly reduced. By the end of the first trimester, blood pressure is minimal and then remains consistently low throughout the second trimester. Compared to pre-pregnancy levels, during this period the systolic “upper” pressure decreases by 10–15 mmHg, and the diastolic “lower” pressure decreases by 5–15 mmHg. However, in III trimester the pressure rises again. By the time of birth, it usually reaches the level it was before pregnancy, or even 10-15 mmHg. exceeds it.

Until recently, arterial hypertension was diagnosed if a pregnant woman’s “upper” blood pressure increased by 30 mmHg. Art. from her normal level and/or diastolic “lower” - by 15 mm Hg. Art. For example, before pregnancy your blood pressure was usually 100/65 mmHg. Art., and then suddenly it increased to 130/82 mm Hg. Art. Previously, this situation was considered pregnancy hypertension. However, since 2013, this diagnostic criterion has been excluded from all international official recommendations.

Essential blood pressure pills for pregnant women(do not take without permission!)

A drug	Dose	Comments
	0.5-3.0 g/day, in 2-3 divided doses	Not recommended during 16-20 weeks of pregnancy because it may affect fetal dopaminergic receptors
Labetalol	200-1200 mg/day, in 2-3 divided doses	May contribute to delay intrauterine development fetus
	30-300 mg/day, sustained release tablets	Causes tachycardia. It is especially risky to take at the same time as magnesium sulfate (magnesium).
Cardio-selective beta blockers (,)	depends on the drug	Large doses increase the risk of hypoglycemia (low blood sugar) in newborns. May reduce placental blood flow.
	6.25-12.5 mg/day	May reduce circulating blood volume and lower potassium levels (hypokalemia)

Hypertension medications contraindicated in pregnant women

Note. Accidentally taking the medications listed above is not a reason to worry too much, much less immediately have an abortion. You need to stop swallowing illegal drugs. Contact your doctor so that he can prescribe the “correct” blood pressure pills instead. Next, you need to perform an ultrasound of the fetus planned dates- 12 weeks and 19-22 weeks.

Insulin resistance is the cause of hypertension in pregnant women in 95% of cases. The remaining 5% have another reason, and this is called secondary arterial hypertension. Almost 3% of pregnant women have hypertension due to kidney disease. U? Of these, the blood supply to the kidneys is impaired due to problems with blood vessels - renovascular hypertension. The rest? - damage to kidney tissue, i.e. renoparenchymal arterial hypertension. Renal hypertension is very common. Therefore, doctors automatically prescribe many of their pregnant patients to undergo ultrasound of the kidneys and Doppler ultrasound of the renal vessels.

In addition to insulin resistance and kidney problems, high blood pressure in pregnant women can be caused by:

magnesium deficiency in the body;
poisoning with heavy metals - lead, mercury, cadmium;
excessive consumption of table salt;
taking certain medications.

Rare but severe causes of secondary hypertension: problems with the thyroid gland, acromegaly, Cushing's syndrome, primary hyperaldosteronism, pheochromocytoma. Read the article “” for more details. These causes of hypertension are especially likely in young women. Therefore, young pregnant women suffering from high blood pressure require especially careful examination.

What is gestational hypertension, preeclampsia and eclampsia

There are the following types of high blood pressure in pregnant women:

Chronic arterial hypertension.
Gestational hypertension.
Preeclampsia.
Eclampsia.

Chronic hypertension - the woman’s blood pressure was high already at the planning stage or began to rise during early stages, until the 20th week of pregnancy. This is despite the fact that in the first and second trimesters, blood pressure should normally decrease. Among young women, the prevalence of chronic hypertension is low. But as age increases, its frequency increases. Among pregnant women aged 30-39 years, chronic hypertension is observed in 6-22% of women.

If a woman has hypertension and takes blood pressure pills, doctors usually categorically discourage her from planning a pregnancy. They are right, because the risk of complications is extremely high. And it's deadly dangerous complications, and not some kind of pimple. If a hypertensive woman decides to get pregnant, then she creates significant problems for herself, her family, and doctors will not be bored either.

If you have chronic hypertension, it is better not to get pregnant. Consider adoption or guardianship. Appreciate what you already have.

Gestational hypertension is when an increase blood pressure first recorded after the 20th week of pregnancy. At the same time, there is no protein in the analysis of daily urine or there is very little of it. Having discovered gestational hypertension, doctors will continue to carefully monitor and force the pregnant woman to undergo frequent tests. This is necessary so that you can immediately take action if the situation suddenly begins to worsen.

If more than 0.3 grams of protein is excreted in the urine per day, then this is preeclampsia - the next step. Severe preeclampsia can cause the negative pregnancy outcomes listed above. Gestational hypertension progresses to preeclampsia in 50% of cases. The main diagnostic criterion is the appearance of protein in the urine of more than 0.3 grams per day. But swelling does not mean that preeclampsia has developed. Because the incidence of edema is 60%, even if the pregnancy is progressing normally.

Diagnostics

Blood pressure measurement should be carried out after a 5-minute rest, while the pregnant woman should be sitting in a comfortable position. It is assumed that she has not performed any vigorous physical activity during the previous hour. A tonometer cuff is usually required to be 12-13 cm wide and 30-35 cm long, i.e. medium size. If the shoulder circumference is unusual - too large or, on the contrary, small - then a special cuff is needed. Because in such cases, a conventional cuff will give a significant error in the results.

The tonometer cuff is placed on the arm so that its lower edge is 2 cm above the elbow bend, and at least 80% of the shoulder circumference is covered. The gold standard for blood pressure measurement accuracy is when the doctor listens to the pulse with a stethoscope. But you can also use a regular home blood pressure monitor - automatic or semi-automatic.

Consultation with medical specialists is needed:

therapist (cardiologist);
neurologist;
ophthalmologist.

Examinations:

electrocardiogram;
24-hour blood pressure monitoring;
Doppler ultrasound of renal vessels;
transcranial Dopplerography of the vessels of the base of the brain;
periorbital Doppler ultrasound (also to assess cerebral blood flow).

complete blood count + schizocytes;
general urine analysis;
biochemical blood test (+albumin, AST, ALT, lactate dehydrogenase, uric acid);
hemostasiogram + D-dimer;
Rehberg test + daily proteinuria (protein in urine) + microalbuminuria (small-diameter protein molecules in urine).

Typical changes in test results during the development of preeclampsia

Laboratory indicators	Changes during the development of preeclampsia
Hemoglobin and hematocrit	These indicators increase due to the fact that the blood thickens. The stronger, the more severe the preeclampsia. However, if hemolysis develops, the indicators decrease. But this also means an unfavorable course.
Leukocytes	Neutrophilic leukocytosis
Platelets	The indicator is decreasing. If less than 100 x 109 /l, then this is a sign of the development of severe preeclampsia.
Peripheral blood smear	The presence of erythrocyte fragments (schizocytosis, spherocytosis) indicates the development of hemolysis in severe preeclampsia
Hemostasiogram	Signs of DIC syndrome
Serum creatinine, Rehberg test	If the amount of urine excreted decreases, while the glomerular filtration rate of the kidneys decreases or, on the contrary, increases, then this is a sign of severe preeclampsia
Uric acid	Elevated levels of uric acid in the blood mean a significant risk of difficult birth, and also predict the transition of gestational hypertension to preeclampsia
ASAT, AlAT	An increase indicates severe preeclampsia
Lactate dehydrogenase	Increases if hemolysis develops
Serum albumin	Decreasing
Serum bilirubin	Increased due to hemolysis or liver damage
Microalbuminuria	If it is detected, then perhaps proteinuria will soon appear
Proteinuria	If hypertension during pregnancy is accompanied by the appearance of protein in the urine, then this should be considered preeclampsia until proven otherwise

Notes on the table:

Hemoglobin is a protein in the blood that contains iron and carries oxygen to tissues. Red blood cells are rich in hemoglobin.
Erythrocytes are red blood cells. They are saturated with oxygen in the lungs and then distribute it throughout the body.
Hematocrit is the portion of blood volume accounted for by red blood cells.
Hemolysis is the destruction of red blood cells with the release of hemoglobin into the blood (an unfavorable process). With hemolysis, the hematocrit decreases.
DIC syndrome (disseminated intravascular coagulation) is impaired blood clotting due to massive release of thromboplastic substances from tissues.
Serum creatinine and Rehberg's test are tests that show how well the kidneys are working.
AST, ALAT - enzymes, increased level which means heart and liver problems.
Lactate dehydrogenase is an enzyme involved in the oxidation of glucose.
Microalbuminuria is the appearance of albumin, protein molecules of the smallest diameter, in the urine. They are the first to appear in the urine in case of kidney problems.
Proteinuria - protein molecules larger in diameter than albumin are found in the urine. Indicates that kidney disease is progressing.

Based on the results of examinations and tests, doctors decide whether a pregnant woman has moderate or severe preeclampsia. This is a fundamental question. If preeclampsia is moderate, the patient is admitted to the hospital and closely monitored. But at the same time, a woman can continue to bear a child. And if the condition is serious, then the patient is stabilized, and then the issue of immediate artificial birth is decided. In any case, hospitalization for preeclampsia is necessary.

Criteria for the severity of preeclampsia

Index	Moderate
Arterial hypertension	140/90 mm Hg.	> 160/110 mmHg
Proteinuria	> 0.3 g, but< 5 г/сутки	> 5 g/day
Creatinine in blood		> 100 µmol/l
Albumin in the blood	normal / reduced
Decreased daily urine output (oliguria)	absent	<500 мл/сут
Liver dysfunction	absent	increase in ALT, AST
Platelets in the blood	normal / reduced
Hemolysis	absent
Neurological symptoms	none
Fetal growth restriction

How to reduce blood pressure in a pregnant woman

The goal of measures to reduce blood pressure in pregnant women is to prevent complications for the mother and fetus during pregnancy and during childbirth. In particular, it is desirable to prevent hypertension from transitioning to. An additional goal is to minimize the overall risk of cardiovascular disease in the long term.

To treat hypertension in pregnant women, first of all, they use a transition to a healthy lifestyle, and then medications. During the first half of pregnancy, blood pressure naturally decreases. This also happens in many women suffering from chronic hypertension. In this case, they can temporarily stop taking blood pressure pills. If later the pressure rises to 150/95 mmHg. Art. and higher, then antihypertensive medications should be resumed.

Doctors and patients are interested in two main questions:

What is the optimal blood pressure level during pregnancy?
What should pregnant women drink if they have high blood pressure? Which drugs are best at reducing the risk of preeclampsia?

Unfortunately, on both of these pressing issues there are as yet no results from serious clinical trials and therefore no official recommendations. However, it is obvious that they really help. At the same time, they are harmless for pregnant women. Read more about them below.

Let us remind you that gestational hypertension is the first detected increase in blood pressure after 20 weeks of pregnancy. It is assumed that before pregnancy and in the first half, the woman’s blood pressure was normal. If gestational hypertension is detected, the patient is often immediately admitted to the hospital to monitor her condition, clarify the diagnosis and reduce the risk of developing preeclampsia. Treatment activities begin quickly.

If hypertension is stage I-II (blood pressure? 180/110 mm Hg), then the prognosis for pregnancy is usually favorable. But the patient requires careful medical supervision and active treatment.

If the therapy gives results, i.e. the blood pressure is moderately increased and the functional parameters of the fetus are stable, then doctors may decide not to keep the pregnant woman in the hospital. In this case, she must visit a doctor every day (!) to monitor the progress of the pregnancy. However, at the first signs, the woman should be hospitalized immediately. She is examined, blood and urine tests are taken to determine the severity of the disease, the condition of the fetus, and the development of further obstetric tactics.

Taking medications for hypertension can reduce placental blood flow, which is harmful to the fetus. Therefore, a woman with preeclampsia is hospitalized and treated in a hospital to monitor the condition of the fetus daily. Blood pressure is monitored not once, but several times during the day. They also monitor the woman’s general well-being, symptoms and test results. The goal is to prolong the pregnancy, prepare for childbirth and carry it out as planned. However, if signs of deterioration in the condition of the mother or fetus appear, then immediate delivery is carried out, i.e. artificial birth.

If preeclampsia developed against the background of chronic hypertension, that is, the pressure was increased even before pregnancy, then the principles of treatment are the same. This is a more severe situation, so pregnant women often have to be prescribed powerful combination blood pressure pills or 2-3 medications at the same time. Women with chronic hypertension are much more likely to have adverse pregnancy outcomes than women with gestational hypertension.

Lifestyle change

As you know, lifestyle changes are the main intervention for treating hypertension, and medications come in second place. However, for pregnant women the recommendations are completely different from those for other categories of patients. Traditionally, doctors recommend a low-calorie diet to lose weight and get rid of hypertension. A low-calorie diet is absolutely not suitable for pregnant women. Also, significant physical activity is not recommended for pregnant women, especially for women with high blood pressure. At the same time, a sedentary lifestyle is harmful for both the mother and the fetus. Walking in the fresh air and aerobic exercise at a calm pace will be beneficial. Carefully avoid stressful situations.

Officially, in order to reduce blood pressure, pregnant women are recommended to eat a diet rich in vitamins, microelements and proteins. Unofficially, but very effectively helps against hypertension. However, during pregnancy, if you overdo it, it can cause ketosis, fetal malformations or miscarriage. Therefore, follow a low-carb diet, but eat fruits, carrots, and beets every day. Eliminate all other foods loaded with carbohydrates that are on the prohibited list. Fruits, carrots, and beets contain moderate amounts of carbohydrates, which will keep you out of ketosis. Vitamins and minerals will also help the child develop.

During pregnancy, it is not recommended to limit table salt in the diet in order to lower blood pressure. Because reducing salt intake reduces the volume of circulating blood, it can disrupt the blood supply to the placenta. Women who suffered from chronic hypertension even before pregnancy need to be careful, as they know for sure that salt sharply increases their blood pressure. This is called “salt-sensitive hypertensive patients.” You can salt your food, but still try not to over-salt it.

Smoking and drinking alcoholic beverages is strictly prohibited. Smoking in pregnant women sharply increases the risk that hypertension will develop into.

What pregnant women can do for blood pressure: medications

For moderately high blood pressure in pregnant women, studies have not shown any benefit from taking “chemical” pills. The risk of development, premature birth, birth of weak children, and perinatal mortality did not decrease. The course of pregnancy and its outcomes did not improve. This means that with blood pressure 140-159/90-109 mm Hg. Art. There is no need to rush into prescribing medications other than magnesium tablets with vitamin B6. Unless there are problems with the heart, kidneys, liver, etc., and the test results are more or less normal.

What to drink for a pregnant woman with high blood pressure - do not solve this issue yourself! The final decision on prescribing medications should be made only by the doctor. Unauthorized taking of any pills is extremely dangerous!

Antihypertensive medications that last 12-24 hours

Simultaneously with measures to provide emergency care, a pregnant woman is prescribed tablets for hypertension, which act for a long time, smoothly and stably. The goal is to prevent the recurrence of sudden pressure surges.

Magnesia (magnesium sulfate, MgSO4) is not officially considered a cure for hypertension. However, in severe cases it is recommended to administer it to prevent seizures. The dosage regimen for magnesium is intravenous only, preferably using a pump. Loading dose 4-6 g of dry matter (possible scheme - 20 ml of 25% solution - 5 g of dry matter) for 5-10 minutes; maintenance dose – 1-2 g of dry matter per hour. We strongly recommend early initiation to relieve hypertension and prevent preeclampsia. These pills significantly reduce the risk that doctors will have to use a potent drug. Please discuss your magnesium B6 intake with your doctor first!

Blood pressure pills prescribed during pregnancy

A drug	Release form, dose	Note
	Tablets 250 mg. Orally 500 mg – 2000 mg per day. The average therapeutic dose is 1500 mg per day, in 2-3 doses. The maximum daily dose in US recommendations is 3000 mg, in European recommendations - 4000 mg.	First-line drug for high blood pressure in pregnant women in most countries. There were no adverse effects observed in animal experiments, and no association between the drug and birth defects when used in the first trimester in humans. Studied in numerous studies in comparison with other blood pressure medications, as well as placebo. Long-term effects on child development were studied.
	Tablets 0.075/0.150 mg. The maximum single dose is 0.15 mg, the maximum daily dose is 0.6 mg. Note that the maximum daily dose in European recommendations is 1.2 mg.	It can be used as a third-line drug for hypertension that is resistant to other drugs. Data on the safety of clonidine are conflicting. No adverse effects in the fetus were detected. However, there are few observations, especially in the first trimester (59 women), for a final conclusion. There are numerous side effects: weakness, drowsiness, dizziness, anxiety, depression, dry mouth, anorexia, dyspepsia.
	Extended-release tablets – 20 mg, modified-release tablets – 30/40/60 mg. The average daily dose is 40-90 mg in 1-2 doses, depending on the form of release. The maximum daily dose is 120 mg. Not to be confused with fast-acting nifedipne for relieving hypertensive crises.	The most studied representative of calcium antagonists for hypertension. Recommended for use in pregnant women as a first or second choice drug. Sufficient application experience has been accumulated. Use with caution simultaneously with magnesium MgSO4 - cases of hypotension, depression of myocardial contractility, myocardial infarction and neuromuscular blockade have been described. However, practice shows the admissibility of simultaneous administration. The actual incidence of neuromuscular blockade is less than 1%.
	Tablets 5/10 mg. Orally 5-10 mg 1 time per day.	Experiments on animals did not reveal any harmful effects on the fetus. Used in pregnant women in Russia and the USA, despite the fact that there are no well-designed clinical studies of use during pregnancy.
Nicardipine		In animal experiments, no teratogenicity was detected, but dose-dependent embryotoxicity was detected. There are data from isolated studies on use during pregnancy (II, III trimester), no adverse perinatal effects were noted.
Nimodipine	Not approved for use during pregnancy in Russian-speaking countries	Studied in a multicenter, open-label study of 1650 women with severe preeclampsia compared with magnesium sulfate. Treatment outcomes for newborns did not differ.
Isradipin	Not registered in Russian-speaking countries	No teratogenicity was detected in animal experiments. Small studies with short follow-up periods have shown safety during pregnancy.
	Tablets 2.5/5/10 mg. Orally 2.5-10 mg 1 time per day. The maximum daily dose is 20 mg.	The drug is teratogenic in rabbits. There are isolated reports (3 observations) on use during pregnancy.
	Tablets 40/80 mg, extended-release tablets 240 mg. Orally 40-240 mg 1-2 times a day, depending on the form of release. The maximum daily dose is 480 mg per day.	No teratogenicity was detected in animal experiments. Used as an antihypertensive and antiarrhythmic drug. There are small studies on use during pregnancy, including in the first trimester, which have not shown an increase in risk.
	Tablets 50/100 mg. Orally 25-50 mg 2 times a day.	Not recommended for use by pregnant women in Germany, Australia, Canada. A small study of 33 women found an association of atenolol with low birth weight. This result was confirmed in several larger studies, with the most pronounced negative effect noted in women who started taking the drug in early pregnancy and received it for a long time.
	Tablets 25/50/100/200 mg. Orally 25-100 mg 1-2 times a day. The maximum dose is 200 mg per day.	Currently, it is the drug of choice for hypertension in pregnant women, if it is advisable to prescribe a beta blocker. The studies did not report symptoms and signs of beta-receptor blockade in fetuses and newborns. In a placebo-controlled study with metoprolol, no data were obtained indicating a negative effect of the drug on fetal development.
		A small study that included 87 women with chronic hypertension showed the effectiveness of the use of bisoprolol from the second trimester of pregnancy.
	Tablets 5/10 mg. Orally 5-10 mg 1 time per day. The maximum daily dose is 20 mg.	In Russia, a report was published on the successful use of betaxolol in pregnant women with hypertension (42 patients). Long-term effects on child development were also studied (15 children, 2 years).
	Tablets 5 mg. Orally 2.5-5 mg 1 time per day. The maximum daily dose is 10 mg.	In the domestic medical literature there is data on the use of nebivolol in humans during pregnancy. There were no adverse effects on the fetus, as well as on the health, growth and development of children during their first 18 months of life.
Acebutolol	Not registered in Russian-speaking countries	There are isolated reports of studies on use during pregnancy, including in the first trimester.
Pindolol	Tablets 5 mg. Orally 5-30 mg per day in 2-3 divided doses. The maximum single dose is 20 mg. The maximum daily dose is 60 mg.	Studies have shown safety for the fetus. Symptoms of beta blockade have not been reported in fetuses or newborns. It had no effect on the fetal heart rate in the experiment.
	Tablets 40 mg. Orally 80-160 mg per day in 2-3 divided doses. The maximum daily dose is 320 mg.	Many undesirable fetal and neonatal effects have been described when taking the drug - fetal growth retardation, hypoglycemia, bradycardia, polycythemia and other symptoms of β-blockade. Doses of 160 mg and above cause more serious complications, but low doses can also be toxic.
Oxprenalol	Not registered in Russian-speaking countries	Studies have been published that indicate a low risk when used during pregnancy.
Nadolol	80 mg tablets. Orally 40-240 mg 1 time per day. The maximum dose is 320 mg per day.	There are data from isolated studies on use during pregnancy, including in the first trimester. There are reports of symptoms of β-blockade in fetuses and newborns.
Timolol	Not registered in Russian-speaking countries (eye drops only)	There are isolated reports on the use of the drug in women during pregnancy.
Labetalol	Not registered in Russian-speaking countries	It has vasodilating properties due to the blockade of vascular receptors. In many international recommendations, it is a first or second line drug for hypertension in pregnant women. Along with methyldopa, it is the most commonly prescribed antihypertensive drug in the world for pregnant women. Numerous studies have shown safety for the fetus. It had no effect on the fetal heart rate in the experiment. Compared to beta blockers, the ability to penetrate the placenta is weak. May cause neonatal hypoglycemia (low blood sugar) when used in high doses.
Prazosin	Tablets 1/5 mg. The initial dose is 0.5 mg, the target dose is 2-20 mg in 2-3 divided doses.	There are isolated reports of use in humans. Not recommended by the Society of Obstetricians and Gynecologists of Canada (2008), due to an increase in stillbirths observed compared with nifedipine in one small study in the treatment of early severe hypertension. Recommended by the Society of Obstetricians and Gynecologists of Australia and New Zealand (2008), along with nifedipine and hydralazine, as a second-line drug.
Doxazosin	Orally, initial dose 1 mg, maximum - 16 mg	No reports of use in humans
	Tablets 25 mg. Orally 12.5-25 mg per day.	Can be used for chronic hypertension as a third-line drug. Most controlled studies included normotensive pregnant women without hypertension. In 567 cases of observation, no specific anomalies were observed when used in the first trimester of pregnancy. Similar data were obtained from the analysis of the Danish (232 pregnant women) and Scottish (73 patients) registers. However, the recommendations of the UK National Institute for Health and Clinical Excellence (2010) do not recommend use in the first trimester. Data on safety for the fetus are assessed as conflicting.
	Tablets 40 mg. Orally 20-80 mg per day	Use is justified if pregnancy is complicated by renal or heart failure.
	Tablets of 1.5 and 2.5 mg. Inside 1 time per day.	Data on the use of indapamide during pregnancy are limited - 46 observations of use in the first trimester.
Hydralazine	Tablets 25 mg. Orally 50-200 mg per day in 2-4 divided doses. The maximum dose is 300 mg per day.	No teratogenic effects have been observed in humans. Used abroad to provide emergency care for severe hypertension during pregnancy. Not recommended for routine therapy. Cases of thrombocytopenia in the newborn and lupus syndrome in the mother have been described.
Isosorbide dinitrate	Tablets 5 mg.	There is little experience with the use of nitrates for gestational hypertension and preeclampsia, and also as a tocolytic. No toxic effects on the fetus were recorded. The use of isosorbide dinitrate may reduce the risk of ischemia and heart attack while lowering blood pressure.

Among the calcium antagonists, verapamil, amlodipine, and especially extended-release nifedipine are most often prescribed to pregnant women for hypertension. Their side effects are nausea, headache, dizziness, allergic reactions, swelling of the legs, excessive drop in blood pressure.

As for beta blockers, no teratogenic effect was observed in any of the representatives of this group in animal studies. However, in humans, neonatal complications have been reported when beta blockers are prescribed:

low blood sugar (hypoglycemia);
respiratory depression;
low blood pressure.

It is possible that birth will occur prematurely when using beta blockers, but this is rare.

Benefits of beta blockers for the treatment of hypertension during pregnancy:

gradual onset of action;
the volume of circulating blood does not decrease;
do not cause orthostatic hypotension;
reducing the incidence of respiratory distress syndrome in newborns.

Side effects:

heart rhythm disturbances (bradycardia);
bronchospasm;
weakness, drowsiness;
dizziness;
depression, anxiety (rare);
the possibility of developing withdrawal syndrome.

Let us recall that ACE inhibitors and angiotensin II receptor antagonists (sartans) are categorically not recommended for the treatment of hypertension in pregnant women.

Most often, pregnant women are prescribed the following for hypertension:

methyldopa (dopegyt);
nifedipine extended release;
cardio-selective beta blockers (primarily metoprolol).

There are no official recommendations regarding which drug helps best. In the first trimester of pregnancy, the use of, first of all, methyldopa, nifedipine and labetalol is allowed. Atenolol is not recommended during pregnancy. If a woman has been treated for hypertension with ACE inhibitors or angiotensin II receptor blockers, then these medications should be stopped before pregnancy. And even more so, as soon as an unplanned pregnancy is diagnosed.

Why methyldopa is the most popular drug

Combination medications for hypertension for pregnant women

In severe cases, pregnant women can and should take combination medications for blood pressure. These are several different drugs that need to be taken at the same time as prescribed by your doctor. They can be under one shell or 2-3 different tablets. Combination drug treatment for hypertension often allows for smaller doses of drugs and thus reduces the risk of side effects.

Two-component combination treatment regimens for hypertension suitable for pregnant women:

methyldopa + calcium antagonist;
methyldopa + diuretic drug;
methyldopa + beta blocker;
dihydropyridine calcium antagonist + beta blocker;
dihydropyridine calcium antagonist + alpha-blocker;
dihydropyridine calcium antagonist + verapamil;
alpha blocker + beta blocker (this combination is used if the cause of hypertension is pheochromocytoma).

Combination treatment regimens for hypertension in pregnant women consisting of three medicinal components:

methyldopa + dihydropyridine calcium antagonist + beta blocker;
methyldopa + calcium antagonist + diuretic;
methyldopa + beta blocker + diuretic;
dihydropyridine calcium antagonist (usually nifedipine) + beta blocker + diuretic drug (usually hydrochlorothiazide in small doses 6.25-12.5 mg/day).

Possible four-component circuits:

methyldopa + dihydropyridine calcium antagonist + beta blocker + diuretic;
methyldopa + dihydropyridine calcium antagonist + beta blocker + alpha blocker;
+ dihydropyridine calcium antagonist + beta blocker + diuretic + clonidine (clonidine).

When is hospitalization needed?

If a woman has increased blood pressure during pregnancy or had chronic hypertension even earlier, then she is admitted to the hospital 3 times as planned:

In the early stages up to 12 weeks - to resolve the issue of the possibility of carrying a pregnancy.
26-30 weeks. During this period, pregnancy creates maximum stress on the blood vessels. Usually, a correction to the blood pressure medication regimen is needed, which is carried out in the hospital.
2-3 weeks before birth. They prepare for childbirth and determine the tactics for its management.

A pregnant woman should be immediately admitted to hospital if the following circumstances or signs are detected:

Severe hypertension, pressure? 160/110 mm Hg.
High blood pressure was first discovered during pregnancy.
Tests or symptoms indicate the development of preeclampsia; the protein content in daily urine increases.

conclusions

In the article, we examined in detail the question of how to reduce blood pressure in a pregnant woman in order to prevent seizures and other complications. We discussed how to switch to a healthy lifestyle in order to better control hypertension and create good conditions for fetal development. It effectively helps against hypertension. Eliminate sugar, bread and flour products, potatoes and even cereals from your diet. This will quickly reduce the pressure to almost normal. However, during pregnancy you should definitely eat fruits, beets and carrots to avoid ketosis.

You have learned in detail which blood pressure pills can be taken by pregnant women and which are absolutely not suitable. Some medications are taken to quickly lower blood pressure, while others are taken daily to prevent spikes. In any case, do not take any pills on your own initiative! Taking medications without permission during pregnancy is extremely dangerous. It can lead to miscarriage and physical and mental defects of the fetus. You need a doctor who will competently prescribe medications. If you do not trust your doctor, consult another specialist.

Irina Zakharova

The list of approved blood pressure pills during pregnancy is not that long. Many drugs contain components that are contraindicated during pregnancy. Treatment should only be prescribed by an experienced specialist. It is he who, taking into account the severity of the patient’s condition and the characteristics of the pregnancy, selects the least safe remedy with an individual dosage.

How does blood pressure affect the condition of a pregnant woman and her unborn baby?

Normal blood pressure readings are at 120 to 80 mmHg. Art. In the first trimester of pregnancy, measurement results may be lower, but in the third, on the contrary, they increase. This happens under the influence of hormones.

During the period of bearing a child, changes occur in a woman’s body that affect the functioning of internal organs and entire systems:

An additional circle of blood circulation is created, which is necessary for the delivery of nutritional components to the fetus.
The amount of circulating blood increases.
Due to the increase in blood volume, the number of heartbeats also increases.

Changes in the functioning of the cardiovascular system most affect blood pressure during pregnancy.

Changes in blood pressure levels lead to a deterioration in the well-being of the woman and the unborn child. The patient is experiencing headaches, weakness, dizziness, nausea, and emotional instability.

As a result of a pathological condition, the child does not receive enough oxygen and nutrients. Fetal hypoxia develops, which leads to premature birth, miscarriage, intrauterine growth retardation and other negative consequences.

Decreased

Low blood pressure can be recognized by poor health, weakness and lethargy. A pregnant woman is worried about frequent dizziness and fainting. Other symptoms of hypotension include:

pressing, throbbing pain in the head;
fatigue even after rest;
rapid heartbeat, tinnitus;
lack of air;
increased sweating;
pale skin, cold extremities.

Pregnancy with hypotension is difficult. The first trimester is accompanied by toxicosis, and in the third trimester gestosis often develops. There is a constant risk of miscarriage and premature birth.

Hypotension negatively affects the condition and development of the fetus, as blood circulation slows down:

Developmental delay develops as a result of impaired transport of oxygen and nutritional components through the placenta to the fetus.
Intrauterine hypoxia appears.
The growth of all organs slows down.
The risk of abnormalities in the development of the child after childbirth.
The tone of the uterus decreases, and natural delivery is impossible.\

It is important to adjust your diet by including more fortified foods, get proper rest (at least 8 hours of sleep at night), eliminate stress and anxiety, and it is recommended to spend more time in the fresh air.

Increased

As a result of increased blood pressure, a woman’s well-being changes:

troubling throbbing pain in the temples and back of the head;
coordination of movements is impaired;
nausea appears, maybe even vomiting;
tinnitus and dizziness;
sweating increases;
darkening of the eyes, decreased visual acuity, appearance of spots;
weakness, drowsiness, irritability.

The condition poses an even greater danger to the fetus:

Due to increased pressure, blood vessels narrow and blood flow slows down. There is a delay in the development of the fetus, since the substances necessary for development do not reach it.
The newborn baby is diagnosed with cardiac abnormalities.
The condition leads to fetal hypoxia, freezing, or the onset of labor ahead of schedule.
Placental abruption often develops, which causes bleeding.

In order not to provoke all these consequences, it is necessary to follow all the doctor’s recommendations. You cannot take medications on your own, or make changes to an already prescribed treatment regimen.

Causes

What factors can cause high blood pressure during pregnancy? The following unfavorable factors can provoke an increase in blood pressure:

chronic hypertension established before conception;
disturbances in the functioning of blood vessels;
diseases of the endocrine system;
diseases of the nervous system;
overweight;
kidney pathologies;
increased hemoglobin.

Blood pressure increases due to poor sleep, being in a stressful, conflict situation, unbalanced diet, and staying in a stuffy room.

Low pressure

Low blood pressure can be caused by external reasons: stress, lack of activity, poor sleep, dehydration, poor nutrition, lack of oxygen. When these factors are eliminated, the pressure returns to normal.

It is more difficult to cope with the internal causes that led to a decrease in blood pressure:

infectious foci in the body;
diseases of the heart and blood vessels;
disturbances in the functioning of the adrenal glands and kidneys;
anemia.

It is imperative to establish the cause of the pathological changes in order to begin proper treatment.

High pressure

A dangerous disease during pregnancy is arterial hypertension. The causes of the disease can be:

heredity;
excitement, worries;
kidney and adrenal diseases;
diabetes;
poor nutrition;
overweight.

During a hypertensive crisis, a woman’s condition deteriorates sharply. There is a feeling of heat throughout the body, nausea and vomiting, dizziness and pain in the head. The risk of developing pulmonary edema, heart attack and stroke increases.

Emergency help to normalize blood pressure

Only the doctor decides what to take to lower the levels. The treatment regimen depends on the state of health and stage of pregnancy. Drug therapy is indicated if the level exceeds 135 by 95 mmHg. Art.:

Approved general medications are Presolol, Dopegit, Labetalol.
For chronic hypertension, Isparidipine.
If fetal retention develops due to hypertension, you can take the medicine “Methyldopa”.
Sometimes it is necessary to take diuretics: Indapamide, Klopamide.
In case of hypertensive crisis, antispasmodics are prescribed: “No-shpa”, “Eufillin”.

If you have a tendency to hypertension, you need to start taking medications such as Magne B6, Magnerot.

"Dopegit" ("Methyldopa")

The drug "Dopegit" effectively reduces blood pressure, has a minimal number of contraindications and does not have a toxic effect on the fetus. Use is considered safe from the 21st week of pregnancy.

The medicinal substance - methyldopa 250 mg, which acts as an active component, reduces the tone of individual centers of the nervous system without a negative effect on the heart.

Tablets are taken before or after meals. The dosage is 2 g per day, divided into four doses. Duration of treatment is 7-10 days.

"Labetalol"

Labetalol tablets will help reduce blood pressure quickly and permanently (the action begins after 15 minutes). Use is allowed from the second trimester. The pills do not have a negative effect on the functioning of the cardiac system of a pregnant woman and do not affect the intrauterine growth of the fetus. The drug is taken 200-600 mg 2 times a day.

"Metaprolol", "Atenolol", "Bisoprolol"

The drugs are interchangeable and belong to beta-blockers. They are often prescribed for hypertension, tachycardia, extrasystole, angina pectoris and coronary heart disease. The difference lies in the duration of action and the amount of active substance.

Attention! All beta blockers impair blood flow to the placenta. As a result, there is a high risk of having a low birth weight baby. Therefore, tablets should be taken under the strict supervision of a doctor.

The action of the tablets is aimed at normalizing upper and lower pressure, improving the functioning of the cardiovascular system, and reducing heart rate. A group of medications is prohibited for use in the first trimester of pregnancy.

Diuretics

Diuretic drugs are often prescribed as part of complex therapy in the treatment of hypertension. They are especially often prescribed during a crisis to relieve swelling. They should not be abused, as diuretics disrupt placental circulation and cause problems with the kidneys.

"Nifedipine", "Isradipin"

The tablets reduce blood pressure by reducing the tone of smooth muscles and dilating the arteries. They can be taken only after the 4th month of pregnancy. "Nifedipine" or "Isradipine" can be prescribed only in exceptional cases.

The tablets relax blood vessels, lower blood pressure, prevent sudden changes in blood pressure, and remove sodium ions. The effect after administration begins 20 minutes later. Only a doctor can calculate a safe treatment regimen and dosage. In most cases, 1 tablet is prescribed twice a day for 5-6 days.

List of harmful drugs during pregnancy

It is risky to take medications that belong to the group of ACE inhibitors: Lisinopril, Quinapril, Spirapril.

The condition of the expectant mother and her child is negatively affected by angiotensin receptor blockers. This group of hypertensive drugs includes: Irbesartan, Losartan, Eprosartan.

You cannot take all these medications for any period of time, they are dangerous due to their side effects. The active components reduce blood pressure in the fetus and lead to deformation of its body parts and organs.

Possible pregnancy complications associated with this pathology

Hypertension causes complications during pregnancy. High risk of spontaneous miscarriage, premature birth, fetal death. The condition of the mother and child is deteriorating, so it is important to contact a specialist in time who will help to safely improve their health.

If you do not start treatment or take antihypertensive drugs yourself, then significant harm is caused to the child. The unborn baby develops disturbances in the functioning of internal organs and entire systems.

For hypotension

When hypotension occurs in pregnant women, blood circulation in the body is disrupted. As a result, the fetus lacks oxygen and nutrients necessary for proper development.

If treatment is not started in time, the condition leads to the development of gestosis. The complication appears in the later stages, the functioning of the woman’s internal organs is disrupted, and a threat to normal childbirth arises.

For hypertension

Hypertension has negative consequences for the development of the health of the unborn child and mother. The disease causes:

development of gestosis;
onset of labor ahead of schedule and miscarriage;
fetal malnutrition;
delayed growth and development of the fetus.

To reduce blood pressure, the doctor prescribes medications that have minimal negative effects on the baby’s development. Hospitalization may be required. In any case, you cannot refuse treatment.

Preventive methods to normalize blood pressure

To keep your blood pressure normal, you should follow a number of preventive recommendations:

consume more foods rich in vitamins and microelements;
avoid excess weight;
rejection of bad habits;
frequent exposure to fresh air;
moderate physical activity;
exclusion of stressful and conflict situations.

Regular visits to the gynecologist, taking measurements and passing the necessary tests will allow you to keep the course of your pregnancy under control. In case of any deviations, consultation with other specialists will be required to help improve the condition and reduce possible risks.

Fluctuations are normal. It becomes a significant problem if its cause is not a child growing in the womb, but disturbances in the functioning of the cardiovascular, endocrine, nervous, and genitourinary organ systems. What methods and means of treatment can be used by a pregnant woman with high blood pressure?

The dangers of high blood pressure and the importance of diagnosis

Treatment of a pregnant woman is fraught with problems in the health of the unborn child and the pregnant woman herself. Establishing an accurate diagnosis allows you to select the dosage of drugs for the woman and child as accurately as possible, determine which ones are suitable in a particular case (for problems with the thyroid gland or kidneys, they will differ significantly), and in what combination to take them. The main question that the doctor must decide is the very possibility of bearing a healthy child in the absence of mortal danger for a woman with hypertension.

Typically, women experience a decrease in blood pressure in the first and second trimester by 10-15 points from the normal level, and in the third - an increase compared to the norm for a woman by 10-15 points. Such fluctuations are considered normal and do not need to be corrected with medications.

Important! Pay attention to your doctor’s prescriptions for medications: each medication requires clear reasoning. Its absence is a reason to change the medical worker.

When the “upper” pressure is from 150, and the “lower” from 95, there is a reason for examining the pregnant woman, additionally. Treatment with any drugs has the main goal of preventing the development of, or. Pathological pressure surges are fraught with significant consequences:

For woman:

stroke;
bleeding;
retinal detachment;
convulsions;
death.

For a child:

developmental delay;
asphyxia;
oxygen starvation;
premature birth;
death.

If high blood pressure is detected, the pregnant woman is advised to undergo an examination by a cardiologist, ophthalmologist, endocrinologist, or neurologist. Tests include general blood and urine tests, kidney ultrasound, cardiogram.

Treatment methods for hypertension in pregnant women

The selection of treatment methods for a pregnant woman is always carried out on an individual basis. Depending on the severity of manifested hypertension, the following is prescribed:

clear cessation of bad habits (smoking, alcohol);
vitamin therapy, taking mineral-containing medications;
moderate diet;
avoidance of strong physical activity and stress, but mandatory walking and a set of exercises;
using herbal medications to lower blood pressure;
antihypertensive tablets with a short duration of action (short-term use);
regular treatment with antihypertensive drugs;
treatment with a complex of drugs to reduce blood pressure at home or in a hospital;
emergency hospital treatment with the possibility of premature birth.

It is best if the woman is under the supervision of doctors during the day, and her blood pressure is taken (at least once every 4 hours), and proper tests are carried out.

Safe and/or mandatory drugs

Taking any antihypertensive drugs during pregnancy should be agreed with your doctor!

Recommended tablets for blood pressure during pregnancy, including for the purpose of minimizing the possibility of hypertension, are Magnicum, Magne B6, or their analogues. They are not hypotensive. The essence of the action: saturating the nervous system with minerals and vitamins, which have a general calming effect, promote the normal conduction of nerve impulses, dilate blood vessels, and, as a result, prevent blood pressure from increasing due to stress factors.

In the first trimester, it is also important to take “Folic acid”: the drug reduces the risk of developing neural tube defects and increases hemoglobin levels. In the second trimester, iodine preparations are added. May be appropriate throughout pregnancy. Contraindications to treatment with these drugs may be personal intolerance, renal or liver failure.

Taking magnesium supplements in the early stages has a positive effect on the treatment of hypertension after 20 weeks: the dosage of antihypertensive drugs is significantly less than in patients who did not take magnesium.

Taking no-shpa can be considered relatively harmless: a vasodilator drug allows you to relieve spasms and relax smooth muscles. This drug can lower blood pressure with minor deviations from the norm, and at the same time reduces pain (headaches, abdominal muscle spasms).

Conditionally safe medications and their combinations

It has been noted that taking any medications for blood pressure during pregnancy can affect the intrauterine development of the fetus or affect the further development of the child. Despite all the risks, there is a list of approved drugs, which differs significantly in medical practices in different countries. Doctors judge the severity of the consequences of drug use based on a few studies on animals, data on women and the development of newborns who were treated during pregnancy, and personal medical experience. Medicines are also prescribed depending on the stage of pregnancy.

Important! The only drug for high blood pressure whose effects were monitored for almost 8 years was Methyldopa: no adverse reactions were detected in mothers, newborns, or developmental abnormalities in children over seven years of age.

Depending on the availability of information about the negative outcome of treatment, drugs for high blood pressure are classified into the following groups:

Group	A drug	Influence
A (safe)	Calcium, magnesium, magnesium, aspirin (in small doses)	No negative effects on the woman or child were identified.
B (conditionally safe)	Hydrochlorothiazide, methyldopa	No negative effects on the fetus or the pregnant woman were detected. Negative results in animals have not been confirmed in human use.
C (harmful)	Papaverine, nifedipine, clonidine, labetalol, hydralazine	There have been no formal studies in humans, or little evidence of adverse effects in humans from treatment. Experiments on animals have clearly shown a strong effect on the fetus. We can assume that the risk of taking the drug is justified.
D (toxic)	Aspirin (in doses more than 150 mg per day)	Can only be used if there is no alternative in an acute crisis situation.
X (poisons)		The risk of taking the drug is not justified. Severe consequences for the fetus are guaranteed.

Usually combined:

Methyldopa and diuretics (side effects from taking the first medication - swelling, can be controlled with diuretics).
Methyldopa and calcium antagonists (the latter change heart rate).
Methyldopa and beta blockers (decreased vascular tone, the amount of blood in one ejection).
, hydrochlorothiazide, beta blockers.
Calcium antagonists, clonidine, diuretics, beta blockers.

The combination of blood pressure pills for pregnant women, the dosage and duration of treatment depend on the causes of hypertension.

Important! Acute conditions (severely increased blood pressure) of a pregnant woman can be treated with the help of magnesium, nifedipine, lebatalol, hydralazine, nitroglycerin.

Chronic treatment (daily use of a drug to control blood pressure) can be carried out through dopegyt. The drug gives good results, but a month or two after taking it there is a need to increase the dose. The usual daily dose is to take 3-6 tablets for blood pressure.

The effect for 12-24 hours at high blood pressure is provided by methyldopa and all medications from group B. The dosage is calculated with the attending gynecologist, often in collaboration with a cardiologist and endocrinologist.

Hospitalization

Women with hypertension before pregnancy are eligible for planned inpatient treatment. It should be noted that patients suffering from hypertension are advised by doctors not to become pregnant at all. The fact is that during pregnancy the health risks, primarily for the mother, are too high due to high blood pressure (thrombosis, stroke, hemorrhage). Chronic non-gestational hypertension must be treated with drugs that have a pronounced toxic effect, which will cause severe complications in the development of the child. The higher the age of the mother and the more concomitant diseases, the more likely the scenario will be.

In the early stages, hypertension causes abortion. Antihypertensive drugs are prescribed in early pregnancy, but the risks are high. A visit to the doctor in the second trimester of pregnancy is mandatory in order to adjust the intake of medications taking into account the development of the fetal circulatory system and its general physical indicators. For women with hypertension in the third trimester, hospitalization will help prepare for proper management of childbirth and possible complications with the child’s health.

Patients in whom hypertension has led to preeclampsia or eclampsia are also subject to treatment in a hospital setting.

It can lead to delivery by cesarean section, sometimes to the birth of a child prematurely.

Forecasts for mother and child

Modern medicine cannot yet guarantee a 100% successful outcome for women and children when treating hypertension with antihypertensive drugs. With timely and correct treatment, it is possible to achieve full term pregnancy, natural birth, and minimal or undiagnosed abnormalities in the child at birth. In any case, after giving birth, both mother and child should be under special care with a pediatrician and cardiologist for at least a year.

In the future, parents should take care of their child’s healthy lifestyle so that genetic predisposition and early treatment do not become the causes of his hypertension.

Hypertension in a pregnant woman can be turned from a death sentence for a child into minor complications during pregnancy, but only with the help of proper drug treatment, preventive therapy, and a healthy lifestyle for the mother in labor. The existing number of drugs makes it possible to select them individually, solving the problem without harming the child, or with minimal complications.

When carrying a baby, hypertension is a fairly common occurrence, so it is advisable for every mother to know what pills can be taken (under the supervision of a doctor!) for blood pressure during pregnancy. Unfortunately, many women do not give due importance to the disease and cause the situation to worsen. But hypertension in pregnant women can pose a great threat to both the mother herself and her unborn child. This disease must be treated.

First, we need to define what arterial hypertension in pregnant women is.

It contains several concepts:

Hypertension. This is when the pressure is above 140/90 mmHg.
Severe hypertension. The pressure exceeds 160/110 mm.
Preeclampsia. High blood pressure + increased protein in the urine. This condition is dangerous for the mother and the unborn baby.
Eclampsia. Cramps.

The best assistant, of course, is prevention - low-carbohydrate nutrition, more vegetables and fruits in the diet, vitamins. But if high blood pressure is a fact, then some measures must be taken urgently.

The very first and mandatory action in this case should be: contact a qualified doctor, and if you need to go to the hospital, there is no need to refuse. The main thing is not to panic. All this can be treated without harm to both parties - the mother and her unborn child.

Treatment methods for hypertension in pregnant women

We will not list here the possible negative outcomes of a frivolous attitude to one’s pressure.

It is important to know that you can’t just take any pill and calm down - there is a huge risk of taking a drug that will harm the child and disrupt its development. Only a doctor should select medications. Deciding on your own what you can drink and what you cannot drink is strictly prohibited. Even vitamins should be prescribed by a specialist. Not to mention the pills.

Moderate hypertension under the supervision of a doctor can be corrected without the use of blood pressure medications. But severe, over 160/110 mmHg, requires immediate intervention, that is, the prescription of medications.

The goal of drug treatment in this case is to prevent complications and prevent the occurrence of preeclampsia and eclampsia. And also the opportunity to reduce the potential risk of heart and vascular diseases in the future.

Blood pressure therapy includes:

Correction of moderate hypertension without antihypertensive drugs.
Monotherapy, or the use of only one drug, with a minimum dosage.
Long-acting drug therapy.
Combination treatment for special cases or to achieve maximum effect.

So, what blood pressure pills can pregnant women take?

Correction without antihypertensive drugs

It is advisable to begin drug treatment gradually, introducing them approximately in this order:

Magnesium and preparations containing this element. Studies of these drugs have shown no risk to the mother and fetus. Often, in order to prevent the occurrence of hypertension or correct an existing but non-critical one, a gynecologist who sees a pregnant woman prescribes magnesium tablets. Its deficiency in the body leads to very unpleasant consequences, and high blood pressure is one of them. By replenishing the deficiency of this element, it is quite possible to normalize blood pressure or keep it in check.
Herbal medicines. They are especially important in the first trimester. Valerian and motherwort are recommended. Tablet forms act slowly; it is preferable to drink decoctions of these herbs.

Drugs that improve blood microcirculation. These include aspirin in small doses. Also a medicine such as dipyridamole. It is relatively harmless, but can only be taken from 16 weeks.
It is allowed, but carefully and under full control, to use antispasmodics such as papaverine from the second trimester. But only when the benefit outweighs the risk.
Calcium in preparations - carbonate, gluconate - from 16 weeks. Calcium carbonate belongs to a safe group of drugs.
Vitamins and antioxidants. They are often used in the prevention and treatment of high blood pressure in pregnant women.

If lifestyle changes, diet and the group of drugs described above are ineffective, then antihypertensive drugs are prescribed.

Prescribing antihypertensive drugs

For severe hypertension, the following medications are prescribed:

Methyldopa or dopegyt. It is not recommended to use it after 16–20 weeks.

Nifedipine. A possible side effect is tachycardia. It should not be used together with magnesium.
Metoprolol. May lower blood sugar.

If there are indications, you can use the following tablets: hydrochlorothiazide, furosemide, verapamil, clonidine, prazosin.

Of all the drugs listed above, only methyldopa belongs to the group of relatively safe ones. For the most part, antihypertensive drugs belong to category C. In the first trimester, and, in general, throughout pregnancy, their prescription must be justified.

Important! Self-medication is strictly prohibited!
The prescribed medications will need to be taken until the end of pregnancy.
Accidentally taking pills that are contraindicated during pregnancy is not a cause for serious concern. You urgently need to stop using them and go to the doctor for “good” medications, plus you can get an ultrasound.

Categories of drug safety during pregnancy

In 1979, a system of safety categories for drugs used in pregnancy was developed.

The absence of harmful effects on the embryo has been proven.
Relatively harmless, do not pose a significant risk.
There is a risk of negative effects on the fetus. Prescribed only if the benefit outweighs the risk.
The risk to the fetus has been proven. They can be used only when vitally necessary.
Embryonic abnormalities are possible. They are taboo for pregnant women. The risk far outweighs the benefit.

The medications listed above and others that relieve blood pressure are classified according to safety categories as follows:

Category A - aspirin in small doses (can reduce the likelihood of gestosis), magnesium B6, magnesium (injections), calcium carbonate.
Category B - methyldopa (dopegyt), hydrochlorothiazide.
Category C - nifedipine, clonidine, metoprolol and others.
Category D is high dose aspirin if you take more than 150 mg per day.

Regardless of which category the pills and injections belong to, self-prescription can only do harm!

Monotherapy

The most popular drug prescribed to mothers is dopegit, or methyldopa. So let's start with it. This is the most studied medicine of all others with a similar effect.

More than a quarter of a century ago, a major large-scale study of the safety of the drug was conducted. Other agents have not been studied this way. Women who took methyldopa during their pregnancy and the children born to them were monitored by scientists for a full 7.5 years. No pathologies, major deviations or other problems were identified!

The drug is quite effective in reducing blood pressure in any position. The effect of the medicine develops several hours after one dose (from 4 to 6) and lasts for at least 12 hours, sometimes reaching a day. If treatment is stopped, the pressure will return to the initial value after 1 or 2 days.

In addition to the fact that it can lower blood pressure, dopegit also:

has a slight sedative effect, which can be observed at the beginning of its use;
can reduce the tone of the nervous system;
stops the development of gestosis.

Dopegit has the following contraindications: liver disease, anemia, heart attack, individual intolerance and others.

At the same time, dopegit has a lot of side effects:

sleep disorder;
depression;
swelling (in this case, diuretics are additionally prescribed);
orthostatic hypotension (a sharp decrease in blood pressure when moving, for example, standing up) and many others.

By the way, depression is also a contraindication to taking the medication. Most likely, it can aggravate an existing problem.

Despite the number of side effects, the first prescription is still mainly this drug. This is due to little knowledge of competitors and because, after all, pregnant women mostly tolerate methyldopa well.

In addition, the study revealed that in the third trimester, women taking Dopegyt had a fetus in much better condition than those who did not take it.

Labetalol is also a blood pressure medication that can be prescribed by your doctor during pregnancy. It is recommended for use by international authorities. Especially in case of contraindications to taking methyldopa (liver disease and others) or its ineffectiveness. It is quite easily digestible and has minimal side effects.

Magnesia (or magnesium sulfate) is not a drug for treating high blood pressure, but it is administered intravenously to prevent seizures if preeclampsia is suspected.

Long-acting agents

If dopegyt does not have the desired effect, calcium antagonists, for example, nifedipine, are prescribed instead or in addition.

Although in obstetrics only long-acting nifedipine is used. Such drugs can be combined normally with other drugs for hypertension (such as dopegit).

Therefore, if a doctor decides to prescribe it to correct blood pressure in the presence of serious indications, then it is better to listen to his professional (this is important!) opinion.

Since the harm of high blood pressure can far exceed all the side effects of drugs.

Combination of drugs

Often, in severe cases, expectant mothers are prescribed combination medications. This means that what you need is contained in one pill or you need to take several drugs together. In what form?

Perhaps like this:

methyldopa + nifedipine;
methyldopa + diuretic;
dopegit + nifedipine + diuretic.

This combination of drugs allows you to reduce the dosage of each, thereby reducing the risk of side effects.

There is no official information that any drug helps better or faster. After all, all these medications are serious, and during pregnancy there are many contraindications to taking medications.

Blood pressure pills should be prescribed if the potential threat to the life or development of the fetus is much less than the benefit they can bring.

Under no circumstances should you treat your blood pressure on your own. This is especially true for those women whose hypertension arose before pregnancy. You should definitely consult a doctor, especially if conception was not planned. After all, the first trimester is the time when all the important organs of the baby are formed, so during this period he needs to be especially protected from all external influences, especially from medications. The pills that the expectant mother usually took are carefully and gradually discontinued, replacing them with others that are approved.

Hypertensive crisis and preeclampsia

What tablets are prescribed for a sharp increase in blood pressure above 170/110 mmHg?

In case of hypertensive crisis and preeclampsia, the following are used:

nifedipine;
clonidine;
magnesia and other drugs.

Antihypertensive therapy in pregnant women should be strictly under the supervision of doctors.

Still, there are currently no drugs that were developed specifically for pregnant women and do not carry a potential risk of developing any complications. Therefore, it is still better, if hypertension is non-chronic, to take preventive measures, that is, to worry about your baby in advance. After all, it is known that up to 30% of women suffer from high blood pressure, especially in the last trimester. And that this percentage is growing.

Therefore, before conception (if it is planned, then undergo a full examination) and during pregnancy:

eat a balanced diet;

Expectant mothers can take pills only as prescribed by a doctor. Drugs that are safe for mother and child are selected.

When can pregnant women take antihypertensive medications?

WHO (World Health Organization) also recommends prescribing the pill during pregnancy for persistent hypertension of 140/90 mm. RT. Art. Canadian obstetricians and gynecologists offer only diastolic pressure above 90 mm as a criterion. If the reading is 160–170/110, the woman is hospitalized to determine the cause of hypertension.

Today there are no completely harmless medications to lower blood pressure in pregnant women.

Attention! Antihypertensive drugs pose the greatest danger in the first trimester, when fetal organs are formed. That is why in the early stages they try not to use antihypertensive drugs, but tablets that help lower blood pressure.

With an unbalanced diet, the cause of hypertension in pregnant women is often a deficiency of magnesium and potassium. Prescription of drugs containing these elements effectively reduces blood pressure. By the way, not only pregnant women, but also all hypertensive patients, doctors prescribe medications and food products containing magnesium and potassium. In the line of drugs of this profile, Magne B 6 and Magnerot are popular.

The role of microelements in hypertension in pregnant women

When a new life is born, a large consumption of nutrients occurs in the mother’s body. All systems are completely rebuilt. With improper nutrition, a deficiency of vitamins and minerals occurs. This leads to disruption of the mother's heart and blood vessels. One of the important elements, magnesium, performs several functions in the body:

significantly reduces blood pressure;
regulates heart rhythm;
prevents the formation of blood clots;
eliminates cramps of the calf muscles in a pregnant woman;
relieves increased uterine tone;
has a calming effect;
regulates electrolyte balance.

In the body, minerals are present in a certain ratio, maintaining the composition of the blood. A deficiency of magnesium and potassium is accompanied by an excess of sodium and calcium. In turn, sodium attracts fluid, which leads to swelling of the legs and increased blood pressure.

Important! After using Magne B6 or Magnerot, the sodium level decreases, which pulls excess liquid with it. This means that leg swelling decreases and blood pressure decreases. There is no need to adhere to a strict salt-free diet.

Thus, Magne B 6 tablets act as calcium channel blockers (), but without side effects. In addition, they enhance the effect of antihypertensive drugs when used together.

Magne B 6 to reduce blood pressure is prescribed 2 tablets 3 times a day for 2 weeks. If after a short course of treatment the parameters do not return to normal, a blood or urine test is performed for magnesium content.

Approved antihypertensive drugs during pregnancy

Anti-pressure tablets differ in effectiveness and speed of release of the active substance. Based on these characteristics, drugs are combined into various groups. To eliminate high blood pressure in pregnant women, medications with different mechanisms of action are used. Currently, specialized tablets of several pharmacological groups are used.

List of permitted means:

Dopegit methyldopa is the most used drug during pregnancy. Representative of centrally acting alpha agonists.
Labetalol belongs to the group of beta blockers with an alpha blocking effect.
Atenolol, Metaprolol, Bisoprolol are beta blockers.
Clopamide and Indapamide are diuretics of the thiazide group.
Calcium antagonists Isradipine, Nifedipine.

The safest tablets for mother and baby are Methyldopa. The drug can be taken without risk even in the early stages of pregnancy, because it does not have a teratogenic (damaging to the fetus) effect.

If hypertension persists when using Methyldopa, use Atenolol and Metaprolol tablets. Beta blockers are more effective at reducing high blood pressure.

In emergency cases, during a hypertensive crisis, Nifedipine or Isradipine are prescribed.

Diuretic tablets are used if the cause of hypertension is excess sodium in the blood plasma.

Dopegyt (Methyldopa)

The most studied and most often prescribed by doctors for hypertension in pregnant women is Dopegit, produced in Hungary. The active substance of the tablets is Methyldopa.

A drug with a central mechanism of action is able to reduce blood pressure by reducing the resistance of peripheral vessels. Methyldopa also reduces heart rate.

Take Dopegit 2 times a day, gradually increasing the dose until the hypotensive effect is achieved. After stabilizing the pressure, the number of tablets is reduced and then discontinued. You can take the product for 1-2 weeks under the supervision of a doctor. The duration of the course depends on the level of hypertension and the condition of the pregnant woman.

Labetalol

The drug is a representative of non-selective beta blockers with a selective blocking effect on postsynaptic receptors. Labetalol compares favorably with Metaprolol. Thanks to its dual action, it dilates blood vessels without reducing cardiac output and reflex tachycardia. In addition, it does not impair renal blood flow.

After oral administration, the tablets are quickly absorbed. The hypotensive effect begins within 20 minutes and lasts 8–24 hours depending on the dose. The active substance penetrates the placenta and enters breast milk.

Indications:

hypertension;
aortic aneurysm;
hypertensive crisis.

Side effects of the tablets are headache, urinary retention, fatigue, depression. Labetalol is prescribed cautiously for diabetes mellitus. The drug masks the signs of hypoglycemia - tremor of the limbs, tachycardia. When taken simultaneously with antidiabetic agents, it causes undesirable reactions. In patients with obstructive bronchial diseases, the development of airway spasm cannot be ruled out.

Contraindications:

bradycardia;
hepatitis;
thyrotoxicosis.

Attention! According to studies, Labetalol does not impair placental blood flow. The drug does not cause intrauterine growth retardation. However, it is not used in early pregnancy. As prescribed by the doctor, the tablets are used from the second trimester.

In pharmacies, Labetalol can be found under the names Abetol, Presopol, Amipress.

Metaprolol, Atenolol, Bisoprolol

The approved tablets from the group of cardioselective beta blockers belong to the second generation. The mechanism of action is to selectively block adrenergic receptors of the myocardium and blood vessels.

Indications:

hypertonic disease;
heart rhythm disturbances - tachycardia, extrasystole;
angina pectoris;
complex treatment for myocardial infarction.

Metoprolol and Atenolol are produced by Russian and foreign companies. An analogue of Betalok ZOK is produced by Sweden, Egilok is produced by Switzerland. Tablets Metaprolol, Bisoprolol, Atenolol effectively reduce upper and lower blood pressure. Reduce heart rate, eliminate arrhythmia, tachycardia. The drugs put the heart into an economical mode. The tablets improve the well-being of patients and reduce the intensity of pain due to angina pectoris.

Contraindications:

individual intolerance;
bradycardia;
hypotension;
heart failure;
cardiogenic shock.

Side effects after taking the tablets are bronchospasm, nasal congestion, deterioration of visual acuity, shortness of breath. Diabetics experience fluctuations in blood sugar. On the part of the nervous system, there is a decrease in memory and confusion.

Beta blockers in pregnant women impair blood flow to the placenta, which leads to the birth of low birth weight babies. The drugs pass through the bloodstream into breast milk.

Metaprolol tablets are prohibited for use in the first trimester because they interfere with fetal development.

Important! Metaprolol is prescribed to pregnant women rarely and according to strict indications, if there is no other choice. The doctor weighs the benefits of the mother's pills against the risk of harm to the baby.

Diuretics

Thiazide diuretics - Indapamide, Clopamide - have a hypotensive, diuretic, and vasoconstrictor effect. Tablets are used in the complex treatment of hypertension. For isolated diastolic pressure, they are prescribed as independent treatments. Pregnant women take 1 tablet per day for 3-5 days.

Like other diuretics, Indapamide is not a first-line drug for an expectant mother.

Attention! Pregnant women are prescribed tablets only for hypertension caused by increased sodium concentration in the blood.

Nifedipine, Isradipin

The drugs belong to class II calcium antagonists. Nifedipine is a dihydropyridine derivative. Available in the dosage form of prolonged-release tablets with slow release of the active substance.

Nifedipine tablets relieve the tone of the smooth muscles that make up the blood vessels and the uterus. Reduces blood pressure by dilating the arteries. They improve coronary blood flow without inhibiting the activity of the heart muscle.

Indications:

Arterial hypertension;
relief of an attack of angina;
Raynaud's disease.

Important! Calcium antagonists Nifedipine, Isradipine are used to reduce blood pressure only in emergency cases. The drug has a teratogenic effect on the fetus.

Sometimes the blood pressure pills for pregnancy Nifedipine and Isradipine relieve uterine hypertonicity. This prevents the threat of miscarriage. But they can be used no earlier than 16 weeks of gestation.

Side effects:

tachycardia;
facial redness;
headache;
swelling of the limbs.

Nifedipine passes into breast milk. A nursing mother is prohibited from breastfeeding her baby during treatment. For liver and kidney diseases, the drug is used only in a clinical setting.

Opinions of pregnant women about antihypertensive pills

Young women often face increased blood pressure as they prepare to become mothers. Some of them take pills and leave reviews online.

Ekaterina, 22 years old, Tomsk
At the 9-month mark, the blood pressure rose to 140/90, and swelling of the legs began. The gynecologist prescribed Dopegit tablets 2 times a day. The effective drug normalized the indicator after a week.
Zhenya, 25 years old, Novosibirsk
Vitamin Magne B 6 was prescribed to me by a gynecologist during my second pregnancy due to hypertension 140/95 and swelling of the legs. I took 2 tablets 3 times a day. After 2 weeks, the pressure returned to normal, the swelling disappeared.
Anyuta, 34 years old, Moscow
When I was young, I suffered from blood pressure changes. In the third trimester the numbers reached 145/90. My doctor prescribed Dopegit. I took 2 tablets a day for 2 weeks. The pressure returned to normal and no longer increased.
Anastasia, 27 years old, Moscow
Magne B 6 helped me when I was 3 months pregnant when hypertension appeared. In addition, my stomach periodically became hard. The doctor said that the reason was a lack of magnesium. Already 3 days after taking Magne B 6, the blood pressure returned to normal. Hypertonicity of the uterus also stopped.
Katie, 39 years old, Moscow
I took Dopegit for 3 days without results. At 160/100 I was admitted to the maternity hospital. Only Metaprolol was prescribed, ½ tablet twice a day. This drug keeps 130/80 mmHg.

If pregnant women's blood pressure begins to rise, it is forbidden to take the pills on their own. Medicines are dangerous for both mother and fetus. The doctor prescribes antihypertensive drugs after the examination. In some cases, taking magnesium tablets is enough to reduce blood pressure.

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What can pregnant women do for high blood pressure? High blood pressure during pregnancy

What is gestational hypertension, preeclampsia and eclampsia

Diagnostics

How to reduce blood pressure in a pregnant woman

Lifestyle change

What pregnant women can do for blood pressure: medications

Antihypertensive medications that last 12-24 hours

Why methyldopa is the most popular drug

Combination medications for hypertension for pregnant women

When is hospitalization needed?

conclusions

How does blood pressure affect the condition of a pregnant woman and her unborn baby?

Decreased

Increased

Causes

Low pressure

High pressure

Emergency help to normalize blood pressure

"Dopegit" ("Methyldopa")

"Labetalol"

"Metaprolol", "Atenolol", "Bisoprolol"

Diuretics

"Nifedipine", "Isradipin"

List of harmful drugs during pregnancy

Possible pregnancy complications associated with this pathology

For hypotension

For hypertension

Preventive methods to normalize blood pressure

The dangers of high blood pressure and the importance of diagnosis

Safe and/or mandatory drugs

Conditionally safe medications and their combinations

Hospitalization

Forecasts for mother and child

Treatment methods for hypertension in pregnant women

Correction without antihypertensive drugs

Prescribing antihypertensive drugs

Categories of drug safety during pregnancy

Monotherapy

Long-acting agents

Combination of drugs

Hypertensive crisis and preeclampsia

When can pregnant women take antihypertensive medications?

The role of microelements in hypertension in pregnant women

Approved antihypertensive drugs during pregnancy

Dopegyt (Methyldopa)

Labetalol

Metaprolol, Atenolol, Bisoprolol

Diuretics

Nifedipine, Isradipin

Opinions of pregnant women about antihypertensive pills

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