References

American Heart Association. In-office measuring blood pressure infographic. 2016. https://targetbp.org/tools_downloads/mbp/ (accessed 3 May 2019)

Baral-Grant S, Haque MS, Nouwen A, Greenfield SM, McManus RJ. Self-monitoring of blood pressure in hypertension: a UK primary care survey. Int J Hypertens. 2012; 2012:1-4 https://doi.org/10.1155/2012/582068

Bateman BT, Bansil P, Hernandez-Diaz S Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol. 2012; 206:(2)134.e1-134.e8 https://doi.org/10.1016/j.ajog.2011.10.878

Bellamy L, Casas JP, Hingorani AD, Williams DJ. Preeclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007; 335:(7627) https://doi.org/10.1136/bmj.39335.385301.BE

Bello N, Woolley J, Lawrence Cleary K Accuracy of blood pressure measurement devices in pregnancy: a systematic review of validation studies. Hypertension. 2018; 71:(2)326-335 https://doi.org/10.1161/HYPERTENSIONAHA.117.10295

Bick D, Beake S, Chappell L, Ismail K, McCance D, Green J, Taylor C. Management of pregnant and postnatal women with pre-existing diabetes or cardiac disease using multi-disciplinary team models of care: a systematic review. BMC Pregnancy Childbirth. 2014; 14 https://doi.org/10.1186/s12884-014-0428-5

Bramham K, Parnell B, Nelson-Piercy C, Seed P, Poston L. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014; 348 https://doi.org/10.1136/bmj.g2301

Brown MA, Magee LA, Kenny LC The hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice. Hypertension. 2018; 72:(1)24-43 https://doi.org/10.1161/HYPERTENSIONAHA.117.10803

Bramham K, Nelson-Piercy C, Brown M, Chappell L. Postpartum management of hypertension. BMJ. 2013; 346 https://doi.org/10.1136/bmj.f894

Bujold E, Roberge S, Lacasse Y Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010; 116:(2, Part 1)402-414 https://doi.org/10.1097/AOG.0b013e3181e9322a

Cantwell R, Clutton-Brock T, Cooper G Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011; 118:1-203 https://doi.org/10.1111/j.1471-0528.2010.02847.x

Carter W, Bick D, Mackintosh N, Sandall J. A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff. BMC Pregnancy Childbirth. 2017; 17:(1) https://doi.org/10.1186/s12884-017-1245-4

Dabl Educational Trust Limited. Automated devices for clinical use. 2019. http://www.dableducational.org/sphygmomanometers/devices_1_clinical.html#ClinTable (accessed 3 May 2019)

de Bernis L, Kinney MV, Stones W Stillbirths: ending preventable deaths by 2030. Lancet. 2016; 387:(10019)703-716 https://doi.org/10.1016/S0140-6736(15)00954-X

Hodgkinson J, Mant J, Martin U Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ. 2011; 342 https://doi.org/10.1136/bmj.d3621

Hodgkinson J, Tucker K, Crawford C Is self-monitoring of blood pressure in pregnancy safe and effective?. BMJ. 2014; 349 https://doi.org/10.1136/bmj.g6616

Saving Lives, Improving Mothers' Care: Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. In: Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2014

Lavallee L, Tucker K, McManus R. Pregnant women are doing it for themselves: Self-monitoring of blood pressure in pregnancy. Br J Midwifery. 2018; 26:(7)451-454 https://doi.org/10.12968/bjom.2018.26.7.451

Magee LA, von Dadelszen P, Rey E Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015; 372:(5)407-417 https://doi.org/10.1056/NEJMoa1404595

Magee L, von Dadelszen P, Singer J The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): is severe hypertension just an elevated blood pressure?. Hypertension. 2016; 68:(5)1153-1159 https://doi.org/10.1161%2FHYPERTENSIONAHA.116.07862

McManus RJ, Mant J, Bray EP Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet. 2010; 376:(9736)163-172 https://doi.org/10.1016/S0140-6736(10)60964-6

Nathan HL, Duhig K, Hezelgrave NL, Chappell LC, Shennan AH. Blood pressure measurement in pregnancy. Obstet Gynaecol. 2015; 17:(2)91-98 https://doi.org/10.1111/tog.12173

Hypertension in pregnancy: diagnosis and management [CG107].London: NICE; 2010

Hypertension in pregnancy Quality standard [QS35].London: NICE; 2013

Hypertension in adults: diagnosis and management [CG127].London: NICE; 2016a

Management of hypertension in pregnancy: NICE shared learning database.London: NICE; 2016b

Antenatal care for uncomplicated pregnancies [CG62].London: NICE; 2019

Better Births: Improving Outcomes of Maternity Services in England.London: NHS England; 2016

NHS Education for Scotland. Midwifery 2020 programme: core role of the midwife workstream. 2010. https://www.nes.scot.nhs.uk/media/1891153/core_role.pdf (accessed 3 May 2019)

O'Brien E, Asmar R, Beilin L European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003; 21:(5)821-848 https://doi.org/10.1097/00004872-200305000-00001

O'Connor D. Saving Babies' Lives: A care bundle for reducing stillbirth.London: NHS England; 2018

Olsen M, Angell S, Asma S A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations. Lancet. 2016; 388 https://doi.org/10.1016/S0140-6736(16)31134-5

Palatini P, Asmar R. Cuff challenges in blood pressure measurement. J Clin Hypertens. 2018; 20:(7)1100-1103 https://doi.org/10.1111/jch.13301

Pickering TG, Hall JE, Appel LJ Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005; 111:(5)697-716 https://doi.org/10.1161/01.CIR.0000154900.76284.F6

Roberts C, Bell J, Ford J, Hadfield R, Algert C, Morris J. The accuracy of reporting of the hypertensive disorders of pregnancy in population health data. Hypertens Pregnancy. 2008; 27:(3)285-297 https://doi.org/10.1080%2F10641950701826695

Royal College of Obstetricians and Gynecologists. Pre-eclampsia – information for you. 2012. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pre-eclampsia.pdf (accessed 3 May 2019)

Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwifeled continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2015; 15:(9) https://doi.org/10.1002/14651858.CD004667.pub4

Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med. 2011; 365:(5)439-446 https://doi.org/10.1056/NEJMcp0804872

Sibai B. Chronic hypertension in pregnancy. Obstet Gynecol. 2002; 100:(2)369-377

Stergiou GS, Alpert BS, Mieke S, Wang J, O'Brien E. Validation protocols for blood pressure measuring devices in the 21st century. J Clin Hypertens (Greenwich). 2018; 20:(7)1096-1099 https://doi.org/10.1111/jch.13294

Tranquilli AL, Dekker G, Magee L The classification, diagnosis and management of the hypertensive disorders of pregnancy. A revised statement from the ISSHP. Pregnancy Hypertens. 2014; 4:(2)97-104 https://doi.org/10.1016/j.preghy.2014.02.001

Webster L, Conti-Ramsden F, Seed P, Webb A, Nelson-Piercy C, Chappell L. Impact of antihypertensive treatment on maternal and perinatal outcomes in pregnancy complicated by chronic hypertension: a systematic review and meta-analysis. J Am Heart Assoc. 2017; 6:(5) https://doi.org/10.1161/JAHA.117.005526

Webster L, Bramham K, Seed P The impact of ethnicity on adverse perinatal outcome in women with chronic hypertension: a cohort study. Ultrasound Obstet Gynecol. 2018a; https://doi.org/10.1002/uog.20132

Webster LM, Webb AJ, Chappell LC. What is the evidence for using labetalol as a first-line treatment option for hypertension in pregnancy?. Drug Ther Bull. 2018b; 56:(9)107-111 https://doi.org/10.1136/dtb.2018.9.000008

Wu P, Haththotuwa R, Kwok C Pre-eclampsia and Future Cardiovascular Health: A Systematic Review and Meta-analysis. Circ Cardiovasc Qual Outcomes. 2017; 10:(2) https://doi.org/10.1161/CIRCOUTCOMES.116.003497

Ying W, Catov J, Ouyang P. Hypertensive disorders of pregnancy and future maternal cardiovascular risk. J Am Heart Assoc. 2018; 7:(17) https://doi.org/10.1161/JAHA.118.009382

Caring for women with chronic hypertension

02 June 2019
Clinical Practice
02 June 2019
Volume 27 · Issue 6

Abstract

The number of women entering pregnancy with chronic hypertension is increasing, predominantly because of rising rates of obesity and pregnancy at advanced maternal age. ‘Chronic hypertension’ is often used interchangeably with the term ‘pre-existing hypertension’, but it is important to remember that a significant proportion of women are newly diagnosed in pregnancy. Chronic hypertension significantly increases the risks in pregnancy for both the mother and the fetus, and these risks are considerably higher than those associated with gestational hypertension or pre-eclampsia alone; therefore, differentiation is important. The midwife is in an ideal position to improve the care of pregnant women with chronic hypertension. This article reflects on and explores the ways in which a midwife might provide support. It outlines the critical role of the midwife in the accurate and prompt identification, assessment, referral and care of the woman with chronic hypertension in pregnancy.

Hypertension in pregnancy affects approximately 10% of women. The reported incidence varies between studies, but it is estimated that 1.3-3% of pregnant women will have chronic hypertension (Sibai, 2002; Roberts et al, 2008; Bateman et al, 2012) and 8.3% will have gestational hypertension (Roberts et al, 2008). The number of women entering pregnancy with chronic hypertension is rising, predominantly because of increasing rates of obesity and pregnancy at advanced maternal age (Seely and Ecker, 2011). Women with chronic hypertension can be sub-divided into those with essential hypertension (ie with no known secondary cause) and hypertension secondary to another medical condition. ‘Chronic hypertension’ is often used interchangeably with the term ‘pre-existing hypertension’, but it is important to remember that a significant proportion of women are newly diagnosed in pregnancy.

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Chronic hypertension
High-risk pregnancy
Midwife
Risk assessment