Drug treatment for severe High BP in pregnancy- WHO Recommendations
The World health organization (WHO) has released 2018 recommendation on high blood pressure (B.P) during pregnancy.
WHO convened an online meeting where an international group of experts – the Guideline Development Group(GDG) - reviewed and approved the recommendations.
Hypertensive disorders of pregnancy are an important cause of severe morbidity, long-term disability and death among both pregnant women and their babies, and account for approximately 14% of all maternal deaths worldwide. Improving care for women around the time of childbirth is a necessary step towards achievement of the health targets of the Sustainable Development Goals (SDGs).
Improving care for women during pregnancy and around the time of childbirth to prevent and treat pre-eclampsia and eclampsia is a necessary step towards the achievement of the health targets of the Sustainable Development Goals (SDGs).
The development of global guidelines ensuring the appropriate use of evidence represents one of the core functions of the World Health Organization (WHO). The primary goal of these recommendations is to improve the quality of care and outcomes for pregnant women, particularly those related to the treatment of hypertension.
1. Women with severe hypertension during pregnancy should receive treatment with anti-hypertensive drugs (strong recommendation, very low certainty evidence)
The guideline development group considered that there is no clinical uncertainty over whether the treatment of severe hypertension during pregnancy is beneficial. This recommendation was made based on expert opinion; the group considered that most maternal deaths related to hypertensive disorders are associated with complications of uncontrolled severe high blood pressure. Based on that, the group agreed that antihypertensive treatment should be recommended in all cases of severe hypertension.
2. The choice and route of administration of an antihypertensive drug for severe hypertension during pregnancy, in preference to others, should be based primarily on the prescribing clinician’s experience with that particular drug, its cost and local availability (conditional recommendation, very low certainty evidence)
- In terms of the choice and route of administration of an antihypertensive drug for severe hypertension during pregnancy, the guideline development group noted that not only is the evidence base for this recommendation limited but also some antihypertensive drugs may not be feasible options in many settings.
- The group acknowledged that hydralazine, alpha-methyldopa, beta-blockers (including labetalol) and nifedipine have been extensively used, and therefore, these agents would seem to be reasonable choices until further evidence becomes available.
- The group noted that there was no evidence to suggest that nifedipine interacts adversely with magnesium sulfate. In addition, the group considered that the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and sodium nitroprusside should be avoided due to safety concerns.
There is a vital need to increase access and strengthen the capacity of health centers to provide high-quality services to all women giving birth. It is therefore crucial that these recommendations are translated into antenatal and intrapartum care programmes at country and health-facility levels.
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