Hypertension Pathophysiology

Hypertension and pregnancy

Pathophysiology:

Hypertension is a chronic elevation of blood pressure that, in the long-term, causes end-organ damage and results in increased morbidity and mortality. Blood pressure is the product of cardiac output and systemic vascular resistance. It follows that patients with arterial hypertension may have an increase in cardiac output, an increase in systemic vascular resistance, or both.

There are 3 stages of hypertension:

Stage 1: (systolic BP 140-159 mm Hg or diastolic BP 90-99 mm Hg): Can be treated with lifestyle modifications and, if needed, a thiazide diuretic

Stage 2: (systolic BP >160 mm Hg or diastolic BP >100 mm Hg): Can be treated with a combination of a thiazide diuretic and an ACE inhibitor, an

Chronic hypertension complicates 3–5% of pregnancies, although this figure may rise, with the trend for women to postpone childbirth into their 30s and 40s. [1, 2]

Signs and symptoms:

Hypertension is rarely accompanied by any symptoms, even if blood pressure readings reach dangerous level .A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage. "Preeclampsia" is a pregnancy complication.[3]

Diagnosis and lab tests:

• The diagnosis of chronic hypertension is based on a known history of hypertension pre-pregnancy or an elevated blood pressure ⩾ 140/90 mm Hg before 20 weeks gestation.

• Urinalysis: in normal pregnancy, the urinary protein excretion increases to some level, the total protein urin is considered abnormal in pregnant women if it exceeds 300mg/24 hours using a urinary dipstick for protein the test detects albumin and results range from negative to 4+, a dipstick value of ( 3+) between 300 and