title: Blood pressure goals and treatment in pregnant patients with chronic kidney disease.
abstract: As the age of pregnant women and prevalence of obesity and diabetes are increasing, so is the prevalence of medical disorders during pregnancy, particularly hypertension and the associated CKD. Pregnancy can worsen kidney function in women with severe disease, and hypertension puts them at risk for pre-eclampsia and the associated complications. There are no specific guidelines for hypertension management in this population, and tight control will not prevent pre-eclampsia. Women with end-stage kidney disease should be placed on intense dialysis regimens to improve obstetric outcomes, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are best avoided. This article will review the rationale for a management plan that includes a multidisciplinary team to discuss risks and develop a plan before conception, antepartum monitoring for maternal and fetal morbidity, individualization of medical management using medications with established records during pregnancy, and balancing the level of blood pressure control proved to protect kidney function against the potential effects that aggressive blood pressure control could have on the fetal-placental unit.
authors.affiliation: Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, the Ottawa Hospital, Ontario Canada; Department of Medicine, Jersey Shore University Hospital Medical Center, Neptune, NJ; Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ.
authors.forename: Asher
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, the Ottawa Hospital, Ontario Canada; Department of Medicine, Jersey Shore University Hospital Medical Center, Neptune, NJ; Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ.
authors.forename: Alan
authors.initials: A
authors.lastname: Karovitch
authors.affiliation: Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, the Ottawa Hospital, Ontario Canada; Department of Medicine, Jersey Shore University Hospital Medical Center, Neptune, NJ; Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ. Electronic address: mpcarson@meridianhealth.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carson
mesh_terms: D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination / Q000379:methods; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration; D011225:Pre-Eclampsia / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D006435:Renal Dialysis / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: CKD; End-stage kidney disease; Hypertension; Pre-eclampsia; Pregnancy