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PIH Blood Pressure ManagementAka: Severe Hypertension Management in Pregnancy, Anti-Hypertensive Medications in Pregnancy

See Also
1. Anti-Hypertensive Medications in Pregnancy
2. Pregnancy Induced Hypertension
3. Delivery Indications in PIH
4. Gestational Hypertension Management
5. Mild PIH Management
6. Severe PIH Management
7. PIH Blood Pressure Management
8. PIH Seizure Prophylaxis
Indications
1. Blood Pressure exceeds 160/100 (Severe Preeclampsia)
Initial protocol until Diastolic Blood Pressure <100
1. Labetolol (Normodyne)
  1. Safe and offers benefits over Hydralazine
    1. Lower Incidence of maternal hypotension
    2. Lower Incidence of ceserean delivery
  2. Start: 20 mg IV bolus every 10-20 minutes prn
  3. Some recommend more aggressive management
    1. Start at Labetolol 20 mg IV for first dose as above
    2. If insufficient effect after 10 min: 40 mg IV
    3. If insufficient effect after 10 min: 80 mg IV
    4. If insufficient effect after 10 min: 80 mg IV
    5. Switch to other drug if no effect with 220 mg total
  4. Oral dosing is safe and effective
    1. May be dosed up to a very high maximum (2400 mg/day)
  5. Contraindications
    1. Avoid in Asthma
    2. Avoid in Congestive Heart Failure
2. Nifedipine XL (Procardia XL)
  1. More rapid control of Hypertension than Labetolol
  2. Avoid short-acting Nifedipine as well as other Calcium Channel Blockers
  3. Could it block calcium as Magnesium Sulfate antidote?
  4. Start: 10 mg PO every 20-30 minutes prn
3. Hydralazine (Apresazide)
  1. Was considered drug of choice due to 30 years of PIH use
    1. Now considered third line (after Labetolol and Nifedipine) due to adverse effects
  2. Adverse effects
    1. Fetal Tachycardia
    2. Maternal Headache or Palpitations
  3. Start: 5 mg IV or 10 mg IM every 20 minutes prn
  4. Maintenance: 5 mg IV or 10 mg IM every 3 hours prn
  5. Switch to another agent if no success
    1. After 20 mg IV total or
    2. After 30 mg IM total
Maintanence medications to keep Diastolic BP <100
1. Methyldopa 250-500 mg PO bid-qid
2. Atenolol 50-100 mg PO qd
3. Metoprolol 25-100 mg PO bid
4. Labetalol 100-400 mg PO bid
5. Hydralazine 10-50 mg PO qid
6. Nifedipine
References
1. (2000) Am J Obstet Gynecol 183(1):S1
2. Sibai (1996) N Engl J Med 335:257

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.