Antihypertensive Use Among Pregnant Women on the Rise Reply

Growing numbers of pregnant women are taking antihypertensive drugs that may harm themselves or their babies, according to a new study published in Hypertension.

Brian Bateman and colleagues analyzed Medicaid data from more than 1.1 million pregnant women. Overall, 4.4% of the women received antihypertensive medications at some point during their pregnancy. From 2000 to 2007 the use of antihypertensive drugs increased from 3.5% to 4.9%. This increase, according to the authors, is “consistent with the rising rates of chronic hypertension and gestational hypertension… which in turn may reflect rising rates of obesity and advanced maternal age in US parturients.”

Exposure to antihypertensive drugs occurred in 1.9% of women during the first trimester, 1.7% during the second trimester, and 3.2% during the third trimester. ACE inhibitors, which are contraindicated in late pregnancy, were used in 4.9% of women who used antihypertensive medications in the second trimester and 1.1% in the third trimester. The authors said that automatic refills and the “prescribing physicians’ failure to ask about the possibility of pregnancy are two plausible explanations.”

About half of women who had been taking antihypertensive drugs prior to their pregnancy discontinued drug treatment during the first or second trimester. According to the authors, although antihypertensive therapy for mild-to-moderate hypertension can prevent progression to severe hypertension it is unknown whether it can reduce the risk of pregnancy complications, including placental abruption, fetal demise, superimposed preeclampsia, preterm birth, or maternal morbidity.

“While we know high blood pressure, or hypertension, occurs in about 6 percent to 8 percent of all pregnancies, we know little about how women and their doctors treat the condition,” said Bateman, in an AHA press release.

The authors pointed out that “there is virtually no data on the comparative effectiveness and safety of the different treatment options for hypertension” in pregnant women. “Research investigating the comparative safety and efficacy of antihypertensive therapy in pregnancy is urgently needed to define the optimal approach to therapy.”

Republished with permission from CardioExchange, a NEJM group publication.

Here is the press release from the AHA:

More pregnant women taking high blood pressure drugs, yet safety unclear

Study Highlights:
  • Nearly 5 percent of pregnant women take high blood pressure drugs — some that may have harmful effects — and the number is increasing.
  • Research is urgently needed on which antihypertensive drugs are safe during pregnancy and how to use them.
DALLAS, Sept. 10, 2012 — Nearly 5 percent of pregnant women are prescribed drugs to treat high blood pressure External link, including some drugs that aren’t considered safe for mothers or their babies, according to new research in the American Heart Association’s journalHypertension.
Use of high blood pressure drugs during pregnancy External link is becoming increasingly common, said Brian T. Bateman, M.D., lead author and Assistant Professor of anesthesia at Harvard Medical School in Boston, Mass.
“While we know high blood pressure, or hypertension, occurs in about 6 percent to 8 percent of all pregnancies, we know little about how women and their doctors treat the condition,” he said.
Researchers studied a database of more than 1 million Medicaid patients, of whom 48,453 (4.4 percent) filled prescriptions for high blood pressure drugs External link during their pregnancies.
They found:
  • Antihypertensive drug use increased from 3.5 percent to 4.9 percent between 2000 and 2006.
  • Antihypertensive drug users were older than non-users, more likely to have diabetes or kidney disease, and more likely to be Caucasian or African-American than Hispanic or Asian.
  • Nearly 2 percent of pregnant women filled prescriptions for these drugs during the first trimester; 1.7 percent during the second trimester; and 3.2 percent during the third trimester.
  • The drugs prescribed included ACE inhibitors and angiotensin receptor blockers — both of which have been shown in studies to have harmful side effects during pregnancy.
Limited information is available about which antihypertensive drugs are safest and most effective for treating high blood pressure during pregnancy, Bateman said. In general, methyldopa and labetalol are the recommended antihypertensives for use during pregnancy. More research on which antihypertensives to prescribe during pregnancy and how to use them safely is urgently needed, he said.
“We know from reports that a number of harmful effects can occur from using ACE inhibitors or angiotensin receptor blockers, especially during the second and third trimester,” Bateman said. “These drugs can cause poor growth, kidney problems and even death of the newborn. If women are taking one of these blood pressure medications and they become pregnant or plan to do so, they and their doctors should discuss treatment choices during pregnancy.”
Co-authors are Sonia Hernandez-Diaz, M.D., Dr.P.H.; Krista F. Huybrechts, M.S., Ph.D.; Kristin Palmsten, M.S.; Helen Mogun, M.S.; Jeffrey L. Ecker, M.D. and Michael A. Fischer, M.D., M.S. Author disclosures are on the manuscript.
The National Institutes of Health funded the study. For more information, visit American Heart Association External link  about high blood pressure and pregnancy.
For the latest heart and stroke news, follow us on twitter: @HeartNews External link.
For the updates and new science from the Hypertension journal, follow @HyperAHA External link.

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