Pathophysiology of pregnancy-induced hypertension

It is estimated that pregnancy-induced hypertension (PIH) affects 7 to 10

per cent of all pregnancies in the United States. Although it is the leading
cause of maternal death and a major contributor to maternal and perinatal
morbidity, the mechanisms responsible for PIH pathogenesis have not yet
been fully explained. Nonetheless, studies over the past decade have
provided a better understanding of the possible mechanisms which are
responsible for PIH pathogenesis. As a result of an irregular cytotrophoblast
invasion of spiral arterioles, the initiating event in PIH tends to be raising
uteroplacental perfusion. Placental ischemia is thought to cause
widespread activation / dysfunction of the maternal vascular endothelium
resulting in increased endotheline and thromboxane production, increased
vascular sensitivity to angiotensin II, and decreased vasodilator
development such as nitric oxide and prostacycline. The quantitative
significance of the different endothelial and humoral factors in mediating
the reduction of renal hemodynamic and excretory function and elevation
of arterial pressure during PIH is still unclear. Researchers are also trying to
elucidate the placental factors that mediate activation / dysfunction of the
maternal vascular endothelium. Microarray gene analysis should provide
new insights into the relation between placental ischemia and hypertension
within the ischemic placenta. Once the underlying pathophysiological
pathways involved in PIH are fully understood, more effective strategies for
preeclampsia prevention will come in.

Medication for management of pregnancy-induced hypertension

Hypertension refers to higher blood pressure and can be broken down into
two categories: primary and secondary. One degenerative disease is
primary hypertension caused by angiogenic degenerative changes. As
China's reproductive policy liberalized and maternal age increases, the
incidence of pregnancy-induced hypertension (PIH) in China has gradually
increased. PIH is not a type of primary hypertension, but there are
differences in the treatment of these two types of hypertension.
First-line drugs such as labetalol, nifedipine, or methyldopa should be taken
via the oral route if blood pressure is ≥ 150/90 mmHg. For chronic
hypertension, other drugs should be added after the first drug at the
highest concentration has been revealed to be ineffective. If the blood
pressure of patients with acute hypertension is ≥ 160/110 mmHg, maternal
stroke or eclampsia can result. If PIH patients are about to deliver, they can
be given labetalol, hydralazine or nifedipine.Moreover, all anti-
hypertensive treatments should be based on considerations of maternal
and fetal safety.