Pressures rising despite meds

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Pressures rising despite meds

Postby librarymama09 » Fri Jun 08, 2012 06:11 pm

Anybody here been put on bp meds, stabelized for a week and then pressures rose again? y bp was 140/90s then 110/70s after bp meds now its 150/90s again. Ugh. No protien in urine. 35 weeks (another week and I may be able to have no nicu stay for the baby) would increasing the dose help or is it inevitable that I will have to deliver? My doc suprised me by thinking she can push me to 39 weeks, is that wise?
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Re: Pressures rising despite meds

Postby alexis » Sat Jun 09, 2012 08:56 am

Meds control the symptom--they don't change the underlying disease. So if you're developing hypertension or preeclampsia, the dose needs to be upped as it progresses. They'll want to keep your BP within a safe range to prevent effects for you and the baby, but if the underlying disease is worsening, your pressures will keep going up.

There's a study called HYPITAT that says that even for mild preeclampsia or gestational hypertension, there is no advantage to waiting for delivery once you are past 37 weeks. There is the March of Dimes "not before 39" push but this is for elective induction--not for medical indication. In your shoes, I would talk to the OB about her thinking. There's a balancing act here. You don't want to deliver earlier than you have to, but you also don't want to push too far.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!
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Re: Pressures rising despite meds

Postby alviarin » Sun Jun 10, 2012 12:47 am

Have they done another 24 hour urine? I'm also on BP meds, and OB says they'll run another 24 hour urine anytime something changes, like an increase in BP or new symptoms. (I had a baseline 24 hour urine run in early pregnancy). With my history of preeclampsia and chronic hypertension my MFM and OB are reccomending delivery at 38 weeks (at the latest, assuming everything goes well).

From what I understand it is pretty common for chronics to need their BP med dose uppped during pregnancy, but it is also good to check for pre-e any time something changes.

Here is a link to the HYPITAT study alexis mentioned already (showing an improvement in maternal outcomes with induction at 37 weeks for hypertension or preeclampsia):
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60736-4/abstract

How often are your appointments now?
Hypothyroid mom to Connor and Claire
(severe pre-e at 38 weeks & "mild" pre-e at 37 weeks)
& baby Annabelle
(chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)
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Re: Pressures rising despite meds

Postby alexis » Mon Jun 11, 2012 06:43 am

Yes, I had a 24 hour run twice in my 3rd trimester when my BP went up a bit. I wound up not needing a med adjustment in the 2nd half of pregnancy. I was warned I might as I'd needed my dose cut in the 1st trimester (I was getting dizzy), but I was so tightly controlled that I stayed within acceptable bounds even with the late pregnancy rise. No PE, though, so not 100% analogous.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!
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