Essential Hypertension

Essential Hypertension

Definition

This is a condition in which the blood pressure is raised much above the normal level before the onset of pregnancy. The diagnosis is made either very early in pregnancy or in the non-pregnancy state. The diagnosis is difficult because there are other conditions which bring about elevated blood pressure e.g. pre-eclampsia and chronic nephritis.

Commonly, a blood pressure of 140/90mMHg is regarded as hypertension but a midwife should not have a fixed figure. Any sharp rise in blood pressure e.g. from 100/60 – 130 /80mmttg should be taken serious even if the level of 140/90 is not yet reached.

Symptoms: 

Usually asymptomatic and is only discoveredon routine physical examination

If symptoms are present, they present as:

·              Throbbing occipital headache or migraine.

·              Weakness, dizziness, visual disturbance.

·              Epistaxis

·              Palpitation

·              Angina pectoris

·              Dyspnoea

Later Signs: It affects the target organs i.e. eyes, kidneys andbrain.

Effects on Pregnancy

·              If  blood pressure is very high, the patient may develop albuminuria and frank pre-eclampsia may set in.

·              A very high blood pressure causes cerebral hemorrhage.

·              Later in pregnancy, it may cause concealed accidental hemorrhage (Abruptio placenta) which may lead to renal complications.

·              On fetus, there is higher incidence of abortion, intrauterine death and premature labor.

·              Generally there is increased maternal morbidity

Management

·              Sedatives – to relax the patient sodium Amytal 200m g 6-8hrly.

·              Hypotensive drugs – reserpine 0.5 – 0.75mg dly, Gua nethidine 10-25mg dly, Methyldopa 250mg tds

Obstetrics

Patient with this condition should not carry pregnancy beyond term. In mild-moderate cases, surgical induction is done (artificial rupture of membrane) at 38-40wks. In severe cases, labour is induced to avoid eclampsia.

Nursing: Ensure bed rest and adequate sleep

Observation: Blood pressure is checked at least twice daily and insevere cases, 4 hourly or 2 hourly. Diet -Low Sodium intake and low alcohol intake

Exercise – Plan daily exercise to maintain weight, lifting iscontraindicated.

Manage stress appropriately.