What is the inpatient management of chronic hypertension with superimposed preeclampsia?

From the Guidelines

Inpatient management of chronic hypertension with superimposed preeclampsia requires prompt intervention with antihypertensive medications, close maternal-fetal monitoring, and timely delivery planning, with first-line antihypertensive therapy typically including labetalol, nifedipine, or methyldopa, as recommended by the most recent guidelines 1. The management of chronic hypertension with superimposed preeclampsia is crucial to prevent maternal and fetal complications.

• The primary goal is to control blood pressure and prevent severe hypertension, which can lead to stroke and other complications.
• First-line antihypertensive therapy typically includes labetalol (starting at 200-400 mg orally twice daily, maximum 2400 mg/day), nifedipine (10-20 mg orally every 4-6 hours, maximum 180 mg/day), or methyldopa (250-500 mg orally every 6 hours, maximum 3 g/day) 1.
• For severe hypertension (≥160/110 mmHg), immediate IV labetalol (20-40 mg initially, then 40-80 mg every 10 minutes, maximum 300 mg) or IV hydralazine (5-10 mg every 20-30 minutes, maximum 20 mg) should be administered to reduce the risk of stroke and other complications 1.
• Magnesium sulfate should be given for seizure prophylaxis (4-6 g IV loading dose over 20-30 minutes, followed by 1-2 g/hour continuous infusion) if severe features of preeclampsia are present 1.
• Continuous fetal monitoring, serial laboratory assessments (complete blood count, liver enzymes, creatinine, uric acid, and urinary protein), and frequent blood pressure measurements (every 1-4 hours depending on severity) are essential 1.
• The timing of delivery depends on gestational age and disease severity—immediate delivery is indicated for uncontrollable severe hypertension, eclampsia, HELLP syndrome, or fetal distress, while patients with stable disease may be managed until 37 weeks 1.
• It is also important to note that women with chronic hypertension in pregnancy should have baseline tests performed at first diagnosis, including a full blood count, liver enzymes, serum creatinine, electrolytes, and uric acid, as well as urinalysis and microscopy 1.
• Long-term follow-up is recommended for these individuals, as they have increased lifetime cardiovascular risk 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Inpatient Management of Chronic Hypertension with Superimposed Preeclampsia

• The management of chronic hypertension with superimposed preeclampsia typically involves immediate stabilization and inpatient treatment with magnesium sulfate, antihypertensive drugs, and corticosteroids for fetal lung maturity if less than 34 weeks' gestation 2.
• Antihypertensive medications such as labetalol, nifedipine, and hydralazine are commonly used to treat hypertensive disorders of pregnancy, including chronic hypertension with superimposed preeclampsia 3.
• Women with chronic hypertension and superimposed preeclampsia are at high risk for adverse maternal and neonatal outcomes, including fetal growth restriction, placental abruption, and perinatal death 4, 5.
• Close monitoring of blood pressure, fetal growth, and maternal well-being is essential in the inpatient management of chronic hypertension with superimposed preeclampsia 4, 5.
• Delivery plans should be made in consultation with the patient and the healthcare team, taking into account the severity of the preeclampsia and the gestational age of the fetus 2.