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  • Title: Hypertension induced by pregnancy, oral contraceptives, and postmenopausal replacement therapy.
    Author: Kaplan NM.
    Journal: Cardiol Clin; 1988 Nov; 6(4):475-82. PubMed ID: 3067841.
    Abstract:
    Hypertension may develop during pregnancy or with the use of OC pills. Although the precise manner by which this rise in blood pressure occurs is unknown, appropriate management of the problem can protect against the consequences. The use of hormonal replacement therapy after menopause is not associated with a rise in blood pressure, and appears to provide significant protection against CHD. Research has shown that some pregnancy induced hypertension (PIH) cases had prior undetected hypertension. For example, a kidney biopsy 6 months postpartum (when all PIH induced morphologic changes have normally subsided in idiopathic PIH cases) revealed that 65.5% of PIH patients actually had renal disease. A 1978-1980 study showed risk factors to include nulliparity, increasing age, black race, multiple gestations, concomitant heart or renal disease, and chronic hypertension. Even though physicians have depended on screening for elevated blood pressures in the 2nd trimester to hedge eclampsia, a study demonstrated that only 8.7% of nulliparas with diastolic blood pressure 80 mm Hg and none 90 mm Hg developed eclampsia. Pathogenesis of PIH appears to be reduced uteroplacental perfusion. This reduction may be caused by disturbed prostaglandin relationships, increased placental production of progesterone, increased amounts of atrial natriuretic peptide, or increased amounts of a digoxin like immunoreactive substance that inhibits the sodium-potassium ATPase pump. Traditional treatment for PIH consists of bed rest, nutritious diet, and hypertensive drugs. A controlled study revealed, however, that drug therapy of maternal blood pressure did not change perinatal outcome and increased fetal growth retardation. Oral contraceptives (OCs) may induce high blood pressure in women 35 years old, smokers, and obese women. This can be managed by using the following guidelines: using the lowest effective OC dose of estrogen and progestin, providing a 6 month supply, monitoring blood pressure frequently, and discontinuing OC use if blood pressure rise 10/5 mm Hg. Postmenopausal hormonal replacement therapy decreases the risk of vascular diseases and does not affect blood pressure.
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