Hypertension and Women

One in 10 American women 45 to 64 years of age has some form of heart disease, and this increases to one in five women over 65. More than half of American women will develop high blood pressure at some point in their lives.

When a woman begins using birth control pills, her blood pressure is apt to increase slightly. The risk appears to increase with age and with length of use. Women who are taking oral contraceptives should get their blood pressure checked regularly. Those who develop hypertension should consider stopping their use of the pill.

Pregnant women can develop a form of high blood pressure in the last three months before delivery that, if not treated, can be hazardous to both the woman and the baby. Although the mother's blood pressure usually returns to normal after the baby is born, sometimes pregnancy-induced hypertension becomes chronic and requires long-term treatment.

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Preeclampsia is a disease characterized by high blood pressure, swelling of the face and hands, and protein in the urine after the 20th week of pregnancy. It is a potentially serious condition that, if left untreated, can lead to complications or death in the mother or the baby.

Preeclampsia used to be called "toxemia," and this term is still familiar to many people. The term was used because the disease was once thought to be caused by a toxin in a pregnant woman's bloodstream. It is now known that preeclampsia is not caused by a toxin, although its true cause remains largely unknown. Because its cause is not known, there is no specific treatment or prevention for preeclampsia. The only sure way to end the preeclampsia is to deliver the baby, sometimes despite the fact that the baby may be premature.

Premature delivery may be necessary because of the serious risks posed by preeclampsia to the mother and the baby. Possible problems for the mother include liver damage, kidney damage, bleeding problems, or seizures. Problems for the baby include not getting enough oxygen or nutrients from the placenta. This problem can lead to growth retardation or fetal distress.

Preeclampsia is a relatively common disorder, affecting 6 percent to 8 percent of all pregnancies. Eighty-five percent of all cases occur in the first pregnancy. Other risk factors for the development of preeclampsia include multiple pregnancy (carrying two or more fetuses), diabetes, chronic high blood pressure, kidney disease, rheumatologic disease (such as lupus), and family history. Preeclampsia is also more common in teen-agers and in women older than 35.

Women who develop preeclampsia often have no symptoms at first. By the time obvious symptoms appear, the condition is often advanced. This is one important reason why your blood pressure is checked at every visit to your doctor during pregnancy.

In some women, the first sign of preeclampsia may be a sudden weight gain – more than 2 pounds in a week or 6 pounds in a month. This weight gain is due to the abnormal retention of fluids, rather than the accumulation of fat. Swelling of the face and hands, headaches, vision problems, and pain in the upper abdomen may also occur.

The diagnosis of preeclampsia begins when your blood pressure is consistently elevated over a period of time. A single high blood pressure reading does not mean you have preeclampsia.

The blood pressure readings your health care provider took during the first trimester of your pregnancy are compared with the ones taken now. Your blood pressure is considered to be elevated if the systolic pressure (the first number) has increased by 30 mm Hg or more, or if the diastolic pressure (the second number) has increased by 15 mm Hg or more, above the pressure in your first trimester. Generally, a blood pressure of 140/90 mm Hg or more is considered above the normal range.

There are various degrees of severity of preeclampsia. If the only sign you have is elevated blood pressure, your doctor may call your condition pregnancy-induced hypertension (PIH).

In addition to high blood pressure, preeclampsia is also diagnosed by detecting large amounts of protein in the urine. This is determined in one of two ways. It can be done by using a test strip that is dipped into a sample of urine. A more accurate method is to collect all your urine over a 24-hour period and then analyze it for protein in a laboratory. Your doctor may also want to do some blood tests to see how well your liver and kidneys are functioning. Blood tests can also confirm that the number of platelets (which are necessary for blood to clot) in your blood is normal.

A syndrome called "HELP syndrome" is a severe form of preeclampsia, distinguished from other milder forms of the condition by elevated liver enzyme values and a low blood platelet level.

The only "cure" for preeclampsia is delivery. Medications to treat high blood pressure in pregnancy are sometimes used, but other measures are usually preferred.

A mild case of preeclampsia may be managed at home with bed rest. How much bed rest you should have depends on your particular case. You will be asked to lie on your left or right side to allow blood to flow more freely to the placenta, and to call your doctor if any symptoms develop. Your doctor may want to see you twice a week to check your blood pressure and urine and to do blood tests, as well as to check on the status of the baby. You may also be asked to take your blood pressure on a regular basis at home.

A more severe case of preeclampsia requires a stay in the hospital. Testing of the baby's well-being, with non-stress tests, contraction stress tests, or biophysical profiles, will be done on a regular basis. In addition to these tests, an ultrasound exam is often used to measure the volume of amniotic fluid. If the amount of amniotic fluid is too low, it is a sign that the blood supply to the baby has been inadequate, and delivery of the baby may be necessary.

When this occurs, the risks of early birth must be weighed against those of the less hospitable conditions inside the uterus. Before this decision is made, amniocentesis may be performed to determine whether the baby's lungs are fully mature. If the health of the mother is thought to be at significant risk, delivery may be necessary before the baby's lungs are fully mature.

Many cases of preeclampsia are mild enough, and arise close enough to the mother's due date, that they can be managed with rest and monitoring until labor starts on its own. In more severe cases, though, labor may have to be induced or a cesarean delivery performed. Magnesium sulfate is a drug that may be given intravenously to the mother with preeclampsia to increase uterine blood flow and to prevent seizures.

A pregnancy complicated by preeclampsia is rarely allowed to go beyond 40 weeks because of the increased risks to the fetus. The "ripeness" of the cervix (whether it is beginning to dilate, efface, and soften) may also be a factor in determining whether labor will be induced.

After delivery, the blood pressure usually returns to normal within several days to several weeks. Blood pressure medication may be prescribed when you are dismissed from the hospital. If blood pressure medication is necessary, its use can usually be gradually stopped a month or two after delivery. Your doctor will want to see you frequently after you go home from the hospital in order to monitor your blood pressure.

The risk that preeclampsia will recur in a subsequent pregnancy depends on how severe it was during the first pregnancy. Wit

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