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Old 11-30-2011
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Sphygmomanometer High Blood Pressure Levels in Pregnancy

A 33-year-old woman is 12 weeks pregnant with her third pregnancy. Her prior two pregnancies were uncomplicated and resulted in two normal spontaneous vaginal deliveries. It has been 7 years since her last delivery, and 4 years ago she was diagnosed with chronic hypertension. She was managed on an ACE-inhibitor but discontinued all medication when she started trying to conceive 6 months ago. She is doing well during the pregnancy except for some mild nausea and rare vomiting. Her physical examination is within normal limits for a woman at 12 weeks’ gestation. Her current blood pressure is 100/60 mm Hg. At which of the following blood pressures should anti-hypertensive therapy be initiated in this patient?

A. 100/60 mm Hg
B. 110/70 mm Hg
C. 120/80 mm Hg
D. 140/90 mm Hg
E. 150/111 mm Hg
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Old 11-30-2011
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D. 140/90 mm Hg
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Old 11-30-2011
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E.

150/111 mm Hg
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  #4  
Old 12-01-2011
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D.140/90mm....i remember that being the criterion for preecclampsia
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Old 12-01-2011
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at 140/90mmhg...i think !!!!!
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Old 12-01-2011
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The correct answer is E. Chronic hypertension affects approximately 5% of pregnant women and is associated with a number of adverse pregnancy outcomes. Pregnant women with chronic hypertension have increased risks of premature birth, intrauterine growth restriction, fetal demise, placental abruption, superimposed preeclampsia, and cesarean delivery. According to the American College of Obstetricians and Gynecologists and the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy, women with mild hypertension (defined as a systolic blood pressure of 140 to 179 mm Hg or diastolic blood pressure of 90 to 109 mm Hg) do not require antihypertensive medication. There is no scientific evidence to demonstrate that lowering blood pressure in hypertensive pregnant women will improve perinatal outcome. Studies comparing pregnant women on antihypertensives such as methyldopa or labetalol with hypertensive pregnant women receiving no treatment have not shown a lower incidence of pregnancy complications in the treated groups. Further, several studies suggest that treated women are more likely to have small-for-gestational-age (SGA) infants. Current recommendations are that hypertensive treatment not be instituted or reinstituted until blood pressures exceed 150 to 160 mm Hg systolic or 100 to 110 mm Hg diastolic.
Blood pressures of 100/60 (choice A) and 110/70 mm Hg (choice B) are normal during pregnancy. Blood pressure typically falls during a normal pregnancy as the pregnancy progresses through the first trimester into the second trimester. The blood pressure then rises as the patient approaches term.
A blood pressure of 120/80 mm Hg (choice C) is considered by many to be normal. During pregnancy, however, most women will have blood pressures lower than this.
A blood pressure of 140/90 mm Hg (choice D) is considered to be an elevated blood pressure. In a nonpregnant patient, persistent elevations to this degree in spite of dietary and exercise changes would lead to the institution of medical treatment. During pregnancy, however, a blood pressure of 140/90 mm Hg should be tolerated in a woman with chronic hypertension. Treatment should be started when pressures are above 150 to 160 mm Hg systolic or 100 to 110 mm Hg diastolic.
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