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In pregnant females, the heart produces extra blood that is pumped and circulated throughout the body, and the blood volume in a pregnant female is increased to 45 % (Guedes-Martins 2016). It is found that in such females the left ventricle becomes larger and thicker; this allows the heart to work extra hard to support the additional blood volume in the body (Sava, March &Pepine 2016). A hormone that causes increased retention of water in the body is called vasopressin, this hormone is released by the pregnant females at high levels. This results in an increase in blood water volume, cardiac output, diastolic volume, and blood pressure (Sava et al. 2016). Moreover, vasopressin as an anti-diuretic hormone constricts the blood vessels and leads to high arterial pressure (Braunthal&Brateanu 2019). All these factors cause high blood pressure that leads to hypertension. According to Tucker andMahajan (2017), the anatomy of blood vessels states that it is made up of 3 layers: adventitia, tunica and muscular tissue (from outer to inner); the walls are made up of endothelial cells and are separated by the basal lamina. These carry blood that contains nutrients and oxygen to various parts of the body.

According to Braunthal et al. (2019), the potential causes of hypertension during pregnancy are as follows:

  • Carrying more than one child – This is because the body is working hard to nourish more than one baby
  • A family history of pregnancy-related hypertension
  • High salt or low potassium levels in the diet – To much salt in the diet causes the retention of fluids in the body leading to high blood pressure/hypertension. However, if the levels of potassium are low inside the pregnant mother’s body then the balance of sodium in the body will not be maintained. As a result, too much sodium will accumulate inside the body, leading to hypertension.
  • First-time pregnancy – The blood vessels in the mother’s body might not widen enough to deliver more nutrients or oxygen to the baby. This failure of vasodilation is also aided by changes in normal hormone levels such as angiotensin, prostacyclin, or others. These are also found to contribute to high blood pressure or pre-eclampsia (Webster, Fishburn&Maresh et al. 2019). 
  • Drinking alcohol – Alcohol intake decreases vasodilation and increased blood pressure leading to hypertension.
  • Smoking – Tobacco damages the blood vessels and narrows them leading to an increase in blood pressure.
  • Not getting enough physical activity – If the physical activity is not enough then the circulation of the blood across the body is not effective; this results in blood pressure issues or hypertension.
  • Obesity/overweight – Obesity leads to endothelial dysfunction, promote insulin resistance, activate renin-angiotensin-aldosterone. These factors contribute to hypertension (Webster et al. 2019).

According to Ankumah and Sibai (2017), the risk factors associated with this condition are as follows:

  • Chronic renal disease
  • Chronic prolonged hypertension
  • Pre-eclampsia in a previous hypertension
  • Superimposed pre-eclampsia
  • High body mass index
  • Multi-fetal gestation
  • Vascular disease
  • Age – The risk of hypertension in pregnancy increases as women age. It is found that after the age of 40, pregnant women suffer from the risks of chronic hypertension in their pregnancies.
  • Heart failure
  • Stroke

According to Chahine and Sibai(2019), the complications with fetal outcomes of this condition if it isuncontrolled are as follows:

  • The chances of normal delivery get reduced or limited and the chances for cesarean section increase.
  • The chances of preterm birth increases in which the lungs, heart, brain, and other major body organs are not completely developed in the baby.
  • The issues of placental abruption also increase (44 % of hypertension pregnant women suffer from placental abruption).
  • Due to hypertension, there is a decreased flow of blood to the placenta, as a result, fetal growth is restricted. The baby is unable to receive adequate amounts of oxygen, water, nutrients, and all these factors contribute to poor fetal growth.
  • If the blood pressure is high then it can lead to bulging or weakening of the blood vessels, this will lead to the formation of an aneurysm. If an aneurysm gets ruptured then it can lead to the death of the mother. Hence it is a life-threatening complication.
  • Hypertension in pregnancy can lead to stress and this will affect the mother and the growth of the baby.
  • Untreated chronic hypertension can also lead to the death of either the mother or the baby/fetus or both.
  • The fetus might get affected by the development of seizures. This can cause serious damage to the fetus.
  • The chances of intrauterine growth retardation and intrauterine fetal death also increase (Lu, Chen&Cai et al. 2018).

According to Chahine et al. (2019), this serious condition can be managed effectively and the unexpected results or outcomes can be prevented with the help of the following methods or approaches:

  • Physical examination for checking of pulses in the four extremities, measurement of blood pressure before and after rest or changes in posture, and funduscopic examination.
  • Use of Nifedipine, Labetalol, Alpha methyldopa, and a few others for treating chronic hypertension in pregnancy. However, these offer some side effects such as tachycardia, drowsiness, hypotension, and headache, therefore, it is required to educate the female about the disease, signs, symptoms, medicines, medication administration, and their side-effects.
  • Frequent monitoring and documentation of the blood pressure records and medications with the evaluation of the response to the prescribed drugs.
  • Encouraging and educating the patient for a healthy diet and self-management for blood pressure to prevent hypertension.
  • The use of antihypertensive drug therapy is useful and effective in the management of chronic hypertension in pregnancy.
  • Doctor visits and ultrasounds should be performed frequently to ensure the safe blood pressure levels and safety of the fetus.
  • Effective pre-pregnancy care such as intake of a healthy and balanced diet, no skipping of medicines or meals, and daily physical activity helps in ensuring the healthy state of the pregnant mother.
  • To ensure the safety of the fetus about its growth and development, biophysical profile and non-stress testing should be conducted.
  • Women should be encouraged to no alcohol or smoking habits. So that the blood pressure is kept under control and the fetus is unaffected (Lu et al. 2018).

References for Chronic Hypertension in Pregnancy

Ankumah, N A E &Sibai, B M 2017, ‘Chronic hypertension in pregnancy: Diagnosis, management, and outcomes’, Clinical Obstetrics and Gynecology, vol. 60, no. 1, pp.206-214, doi: 10.1097/GRF.0000000000000255

Braunthal, S &Brateanu, A 2019, ‘Hypertension in pregnancy: Pathophysiology and treatment’, SAGE Open Medicine, vol. 7, pp.2050312119843700, doi:10.1177%2F2050312119843700

Centre for disease control and prevention 2020, ‘High Blood Pressure During Pregnancy’, figure, viewed 5Octuber 2020,

Chahine, K M and Sibai, B M 2019, ‘Chronic hypertension in pregnancy: New concepts for classification and management’, American Journal of Perinatology, vol. 36, no. 02, pp.161-168, doi: 10.1055/s-0038-1666976

Guedes-Martins, L 2016, ‘Chronic hypertension & pregnancy’, Hypertension: From basic research to clinical practice, pp. 395-407, Springer, Cham, doi: 10.1007/5584_2016_81

Lu, Y, Chen, R, Cai, J, Huang, Z & Yuan, H 2018, ‘The management of hypertension in women planning for pregnancy’, British Medical Bulletin, vol. 128, no. 1, pp.75-84, doi: 10.1093/bmb/ldy035

National Blood, Lung and Heart Institute 2019, ‘Chronic hypertension in pregnancy: To treat or not to treat’, figure, viewed 5Octuber 2020,

Podymow, T & August, P 2017, ‘New evidence in the management of chronic hypertension in pregnancy’, Seminars in Nephrology, vol.37, no. 4, pp. 398-403, doi: 10.1016/j.semnephrol.2017.05.012

Sava, R I, March, K L &Pepine, C J 2018, ‘Hypertension in pregnancy: Taking cues from pathophysiology for clinical practice’, Clinical Cardiology, vol. 41, no. 2, pp.220-227, doi:10.1002/clc.22892

Tucker, W D & Mahajan, K 2017,‘Anatomy, blood vessels, Europe PMC,

Webster, K, Fishburn, S, Maresh, M, Findlay, S C & Chappell, L C 2019, ‘Diagnosis and management of hypertension in pregnancy: Summary of updated NICE guidance’, TheBMJ, vol. 366, pp.l5119, doi: 10.1136/bmj.l5119

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