BMJ：妊娠中高血圧治療：NICEガイダンス要約

子癇前症、分娩時卒中、ARB・ACE阻害剤禁忌など話題に事欠かない分野で、”妊娠高血圧学会”なるものも存在する。重要性が高い問題である。

NICE:Hytertension in pregnancy
http://www.nice.org.uk/CG107

Management of hypertensive disorders during pregnancy: summary of NICE guidance
BMJ 2010; 341:c2207 doi: 10.1136/bmj.c2207 (Published 25 August 2010)
Cite this as: BMJ 2010; 341:c2207

定義

・Chronic hypertension:: hypertension present at booking visit or before 20 weeks’ gestation, or being treated at time of referral to maternity services; can be primary or secondary in aetiology

・臨床的顕性たんぱく尿：Clinically relevant proteinuria: more than 300 mg protein in a 24 hour urine collection or more than 30 mg/mmol in a spot urinary protein:creatinine sample

・ HELLP syndrome: haemolysis, elevated liver enzymes, and low platelet count

・Gestational hypertension: new hypertension presenting after 20 weeks’ gestation without clinically relevant proteinuria

・Mild hypertension: diastolic blood pressure 90-99 mm Hg, systolic blood pressure 140-149 mm Hg

・Moderate hypertension: diastolic blood pressure 100-109 mm Hg, systolic blood pressure 150-159 mm Hg

・Pre-eclampsia: new hypertension presenting after 20 weeks’ gestation with clinically relevant proteinuria

・Severe hypertension: diastolic blood pressure 110 mm Hg or greater, systolic blood pressure 160 mm Hg or greater

・Severe pre-eclampsia: pre-eclampsia with severe hypertension or with symptoms, biochemical abnormalities, or haematological impairment (or any combination thereof)

要約テーブル：http://www.bmj.com/content/341/bmj.c2207/T1.expansion.html

治療に関して・・・

軽症：治療なし
中等症・重症：経口labetalol（第一選択）：拡張期血圧　８０－１００ mmHg、収縮期血圧　＜１５０ mmHg