Paweł Radkowski, Urszula Salak, Wiktor Jakub Kaczmarek, Justyna Opolska, Hubert Oniszczuk, Marek Gowkielewicz

Pharmacotherapy of Hypertension in Pregnancy and the Postpartum Period: Current State of Knowledge

 

2025-09-12

Research Subject. This article deals with hypertension in pregnancy, one of the most serious complications of pregnancy and childbirth. It covers both chronic hypertension and hypertension developing during pregnancy (gestational hypertension, pre-eclampsia, and eclampsia) and presents the classification, pathophysiology, and hemodynamic changes in pregnant women. The article also discusses recommendations for diagnosis and pharmacological treatment in accordance with the current guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC).

Objective of Research. The purpose of this study was to present current knowledge on the pathogenesis, classification, and treatment of hypertension in pregnancy. It also focuses on the consequences of uncontrolled hypertension for the mother’s and child’s health, compares available therapeutic methods, and analyzes current ESH, ESC, and other American and Polish guidelines. The article also considers blood pressure measurement methods, diagnostic criteria, and the safety of antihypertensive drugs during pregnancy and before conception.

Material and Methods. The authors conducted a literature review using the PubMed database, where articles containing the keywords “hypertension”, “pregnancy”, “pharmacology of hypertension in pregnancy”, and “hypertension in pregnancy” were searched. In the analysis, the study included reviews and original publications on pharmacotherapy of hypertension in pregnancy and excluded conference abstracts, letters to the editor, commentaries, and opinion articles.

Results. The study showed that appropriately selected and early implemented antihypertensive therapy significantly reduced the risk of complications such as preterm labor, eclampsia, low neonatal birth weight, and maternal death. Labetalol, long-acting nifedipine, and methyldopa have been recognized as first-line drugs for the treatment of moderate to severe hypertension, while drugs such as angiotensin-converting enzyme inhibitors (ACEI), spironolactone, and eplerenone were considered potentially toxic. They have no place in modern treatment regimens. In emergency situations, intravenous treatment with a rapid onset of action is recommended. Pharmacotherapy should be preceded by risk assessment, and treatment should be tailored to the patient’s individual clinical situation.

Conclusions. Hypertension in pregnancy requires a special diagnostic and therapeutic approach. Early detection of the disorder, accurate classification, and implementation of treatment based on current guidelines are crucial. Adequate control of blood pressure can significantly improve the prognosis of both mother and child. Interdisciplinary cooperation (gynecologist, hypertensiologist, neonatologist) for minimizing the risk of complications is very important. The current 2024 guidelines standardize the therapeutic approach and emphasize the importance of individualizing therapy.

Keywords: Hypertension, pregnancy-induced, pre-eclampsia, antihypertensive agents, drug therapy.

© Farm Pol, 2025, 81(1): 31–41