CHRONIC HYPERTENSION

Chronic hypertension, defined as a systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg diagnosed before pregnancy or before 20 weeks of gestation or first detected during pregnancy and continuing after the 12th week postpartum is associated with increased maternal and perinatal mor-bidity and mortality. Approximately 13-40% of pregnant women with chronic hypertension develop superimposed preeclampsia, a condition that further exacerbates risks such as placental abruption, fetal growth restriction (FGR), and preterm birth. Preconception counseling is crucial to optimize ma-ternal health before pregnancy. Assessment of end-organ function, review of current antihypertensive medications, and modification of modifiable risk factors like obesity and diabetes should be under-taken. Medications such as ACE (Angiotensin converting enzyme) inhibitors and ARBs (Angiotensin receptor blocker) should be discontinued due to teratogenicity. During pregnancy, antihypertensive treatment is generally initiated when blood pressure reaches ≥140/90 mmHg, especially in women with end-organ damage or comorbidities. For patients with acute severe hypertension (≥160/110 mmHg), immediate treatment within 30-60 minutes is essential to prevent maternal complications. Oral nifed-ipine, IV labetalol, and IV hydralazine are first-line agents. Overcorrection of blood pressure should be avoided to prevent placental hypoperfusion. Antenatal fetal surveillance is recommended in cases requiring antihypertensive therapy or complicated by growth restriction or suspected preeclampsia. Protocols may include fetal growth ultrasound every 2-3 weeks, NST (non-stress test) from 32 weeks, and Doppler studies when indicated. Delivery timing should be individualized. In the absence of com-plications, delivery is recommended at 38 0/7 to 39 6/7 weeks. If antihypertensive therapy is used, delivery may be planned from 37 weeks. Earlier delivery is warranted in cases with severe features. Postpartum care includes close blood pressure monitoring, especially within the first two weeks. Given the potential adverse maternal and fetal outcomes associated with chronic hypertension, precon-ception evaluation, close monitoring during pregnancy, and appropriate management strategies are of paramount importance.