How should I choose antihypertensive medication when I have gestational hypertension?

The goal of antihypertensive treatment for hypertension in pregnancy is to prevent serious maternal and fetal complications such as cardiovascular and cerebrovascular accidents and placental abruption. Timing of antihypertensive treatment Pregnant women with hypertension whose systolic blood pressure is ≥160mmHg and/or diastolic blood pressure is ≥110mmHg should be treated with antihypertensive treatment; hypertensive patients with systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg can also apply antihypertensive drugs to avoid serious maternal-fetal complications and to lengthen the gestational week. Targets of antihypertensive reduction For pregnant women without complication of organ function damage, systolic blood pressure should be controlled at 130~155mmHg and diastolic blood pressure should be controlled at 80~105mmHg; for pregnant women with complication of organ function damage, systolic blood pressure should be controlled at 130~139mmHg and diastolic blood pressure should be controlled at 80~89mmHg, and the process of antihypertensive reduction strives for a smooth decline without excessive fluctuation, and the blood pressure should not be lower than 130 /80mmHg, in order to ensure the blood supply of the uterus and placenta, try to protect the target organ function of the pregnant woman and prolong the gestation period to the maturity of the fetus. In case of severe hypertension or organ damage such as acute left ventricular failure, the blood pressure should be lowered urgently to the target blood pressure range, taking care not to lower the blood pressure too much, 10%~25% of the mean arterial pressure (MAP) is appropriate, and stabilization should be achieved in 24~48h. General treatment Non-pharmacological treatment is suitable for all patients with hypertensive disorders in pregnancy, strengthening blood pressure monitoring and limiting physical activity, and bed rest for severe cases. Although strict restriction of salt intake can help to lower blood pressure, it may lead to a decrease in blood volume and adversely affect the fetus, so such patients should be moderately restricted in salt. Ensure adequate sleep, if necessary, oral diazepam 2.5-5.0mg before bedtime. Selection of antihypertensive drugs is based on the following principles: small impact on the kidneys and the placenta-fetal unit, smooth lowering of blood pressure; the first choice of oral antihypertensive, the second choice of intravenous antihypertensive drugs; can be combined with the use of drugs. Selection of antihypertensive drugs 1, Labetalol: is both α-receptor and β-receptor blocking effect of drugs, antihypertensive effect is significant and fewer side effects, so it can be prioritized. 2, nifedipine: nifedipine will not have adverse effects on the fetus when taken in the early and middle stages of pregnancy, so it can also be preferred for hypertensive patients in the early and middle stages of pregnancy. 3.Diuretics: controversial. They can make pregnant women hypovolemic and cause electrolyte disorders. However, meta-analysis shows that diuretics do not adversely affect the fetus and can benefit the pregnant woman. It is recommended that pregnant women who have been treated with thiazide diuretics before pregnancy can continue to apply, and should be discontinued if complicated by preeclampsia. 4, ACEl and ARB: teratogenic effect is certain, pregnancy is absolutely prohibited, women of childbearing age plan to stop before pregnancy.