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Contraindicated in those with risk of bronchospasm
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Intubation Hypertension
Concept
Chapter
# Summary


Chronic hypertension and gestational hypertension are common conditions that may affect pregnant women. They are defined by consistently high blood pressure readings over a certain threshold. Typical signs and symptoms include elevated blood pressure readings, with gestational hypertension specifically presenting after 20 weeks of gestation with no proteinuria. Differential diagnosis may include preeclampsia and chronic kidney disease. Investigations primarily focus on blood pressure monitoring and urinalysis. Management strategies include the use of safe anti-hypertensive medications, such as labetalol, methyldopa, and nifedipine, and regular monitoring.


# Definition


Chronic hypertension refers to high blood pressure that predates pregnancy or is diagnosed before 20 weeks of gestation. Gestational hypertension, on the other hand, is the onset of high blood pressure after 20 weeks gestation without the presence of proteinuria.


# Epidemiology


Both chronic and gestational hypertension are common conditions amongst pregnant women. It is crucial to manage these conditions effectively to prevent complications such as preeclampsia and low birth weight.


# Aetiology


The causes of chronic and gestational hypertension are multifactorial, often involving genetic predisposition, lifestyle factors, and physiological changes during pregnancy.


# Signs and Symptoms


They are primarily asymptomatic but are detected through elevated blood pressure readings. Gestational hypertension specifically presents after 20 weeks of gestation with no proteinuria.


# Differential Diagnosis


- Preeclampsia: Characterized by high blood pressure and damage to another organ system, most often the liver and kidneys, after 20 weeks of gestation.
- Chronic Kidney Disease: Typically presents with proteinuria, haematuria, and a rise in serum creatinine.

# Investigations

Investigations primarily focus on blood pressure monitoring and urinalysis. Regular monitoring and testing are recommended to track the course of the condition and evaluate the effectiveness of treatments.

# Management

Management strategies for chronic and gestational hypertension in pregnancy include:

- Discontinuation of some anti-hypertensive medications (particularly ACE inhibitors or ARBs) and switching to pregnancy-safe alternatives such as labetalol.
- Regular blood pressure monitoring.
- For gestational hypertension above 140/90 mmHg, offer pharmacological treatment; first line management is oral labetalol.
- If labetalol is not tolerated, alternatives include methyldopa and nifedipine.
- Regular urinalysis is recommended for all women.

# NICE Guidelines

[NICE - Hypertension in
pregnancy: diagnosis and
management](https://www.nice.org.uk/guidance/ng133/resources/hypertension-in-pregnancy-diagnosis-and-management-pdf-66141717671365)


117
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Hypertension 
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75
GP
# Drug choice feedback

This gentleman has new-onset stage 2 hypertension and requires pharmacological treatment based on NICE guidelines. Given his age and ethnicity, and the absence of diabetes mellitus, he qualifies for a calcium-channel blocker. In light of the use of a beta-blocker for prophylaxis of migraine, any non-dihydropyridine calcium-channel blockers are contra-indicated. The above options include only those that are of the dihydropyridine type.

# Dose/Route/Frequency/Duration feedback

Each medication has its own optimal dose. All are orally taken and have varying dosing frequencies.
6771
PrescriptionAnswer
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10 mg
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nifedipine 10 mg m/r (Adipine® MR) tablets
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3 months
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daily (OD)
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oral (PO)
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PrescribeAnswerData
2 mg
PrescribeAnswerData
lacidipine 2 mg tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
lercanidipine hydrochloride 10 mg tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
nicardipine hydrochloride 20 mg capsules
PrescribeAnswerData
3 months
PrescribeAnswerData
three times daily (TDS)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
nicardipine hydrochloride 20 mg capsules
PrescribeAnswerData
3 months
PrescribeAnswerData
three times daily (TDS)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
nicardipine hydrochloride 20 mg capsules
PrescribeAnswerData
3 months
PrescribeAnswerData
three times daily (TDS)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
nifedipine 10 mg m/r (Coracten SR®) capsules
PrescribeAnswerData
3 months
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
nifedipine 10 mg m/r (Tensipine MR®) tablets
PrescribeAnswerData
3 months
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daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
30 mg
PrescribeAnswerData
nifedipine 30 mg m/r (Adipine® XL) tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
twice daily (BD)
PrescribeAnswerData
oral (PO)
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PrescribeAnswerData
40 mg
PrescribeAnswerData
nifedipine 40 mg m/r (Fortipine LA 40®) tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
twice daily (BD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
30 mg
PrescribeAnswerData
nifedipine 30 mg m/r (Coracten XL®) capsules
PrescribeAnswerData
3 months
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
nifedipine 10 mg m/r (Nifedipress® MR) tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
twice daily (BD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
5 mg
PrescribeAnswerData
felodipine 5 mg m/r tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
5 mg
PrescribeAnswerData
amlodipine 5 mg tablets
PrescribeAnswerData
3 months
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 62-year-old white gentleman returns to his GP to receive the results of his ambulatory blood pressure monitoring. It is determined to be 158/97mmHg. His estimated 10-year risk of cardiovascular disease is 7%.




## PH


Allergic rhinitis, Migraine


## DH


Fexofenadine hydrochloride 120mg PO OD PRN, Propranolol 80mg PO BD (NKDA)


## On examination


Alert and oriented. Neurological examination normal. Fundoscopy normal.


Temperature 36.0°C, HR 72, RR 14, BP 161/94, O<sub>2</sub> 100% RA, GCS 15, Weight 82kg


## Investigations


Urine dipstick negative


BM: 5.2 mmol/L (normal range 3.5-5.5 mmol/L)


# Prescribing Request


Write a prescription for one drug that is most appropriate for treating his condition.