Questions for the chronic hypertensives

[Raposa]

So, my blood pressure is still high in spite of increasing the labetalol again, so I'm wondering...

If you're a chronic, was it unmasked by pregnancy, or did you have the condition before you conceived?

How long did it take to get it under control? Did you have to switch medications?

Did you have to switch during pregnancy? How did it go?

If it was new with your pregnancy, did you get it under control during the pregnancy?

Did you go on bedrest? Did it help?

I'm stressing out over this, and I'm hoping to hear from others who've been on this particular roller coaster. I just want this to straighten out so I won't have to worry so much.

[ellemoon]

I'm chronic hypertensive and I have been since I was 17. I also have tachycardia, so I have to be on a beta-blocker to slow my heart rate. Labetolol is similar to what I was on before because it is a form of a beta-blocker. What were you taking before pregnancy? Maybe you just need a different medication. For my pregnancy I was put on Methyldopa (Aldomet) and looking back, I should have been on Labetolol but they didn't figure that out until too late.
My pressures were pretty well controlled before I got pregnant and during the first trimester. My blood pressure was always around 130/80 though. I had HORRIBLE swelling from about 23 weeks on.
My BP really started to spike at 27 weeks but protein was negative. At 28 weeks 2 days, the protein showed up pretty much over night and it was over 1900 on the 24 hour. I delivered at 29 weeks 1 day.
If your BPs aren't controlled with what you are currently taking, you definitely need your doctor to adjust it. Are you seeing a MFM (high risk doctor)? If not, you should. My OB never sent me to a MFM during my pregnancy even though I was chronic. I really wish I would have known how important it was. I feel like maybe I could have gotten a little farther along.
But definitely get those pressures under control. I know you can take Labetolol up to 3 times a day. So, your dose may not be high enough. Talk to your doctor. Good luck!!

[Raposa]

I'm up to 300 3x a day! I have an appointment with the MFM tomorrow; at my previous appointment where they upped my dose, they said they might try a calcium channel blocker if the increased labetalol wasn't keeping my blood pressure down well enough. So, here I am with 142/90 at the last check.. which is almost exactly what it was at the appointment where they increased my dose.

I see the MFM and a regular OB, and my regular OB is watching me like a hawk! She supports the idea of getting me out of work for at least modified bed rest. I have disability available for up to 6 months, so we're going to have a chat about that at my 20 week appointment (with ultrasound) to figure out when the best time to stop working would be for me.

Oh, and I didn't take anything before pregnancy. Before, I was 128/60 as recently as an appointment in March. I went to the ER with pain in my left arm and chest and nausea (thought I was having a heart attack) when I was around 8 weeks, turned out it was very high blood pressure. It was hitting 200/120. So, this is new to me.

[alexis]

My chronic HTN was unmasked during my first pregnancy. It never normalized. In that pregnancy I never used antihypertensives (from what I gather, practice where I gave birth seems to be not to give them for mild hypertension). No bed rest. My BP rose very slowly from around 32 weeks (I had a baseline of 140/95, ultimately at 160/105).

My doctor put me on metoprolol (another beta blocker) 18 months later. When I switched docs, she said she would prefer me on an ACE inhibitor but that she didn't want to switch now as I wasn't on BC (ACEi is not safe for pregnancy). I stayed on the Toprol throughout my second pregnancy. I actually had to lower the dose a bit in my first trimester as I was getting dizzy (I was tightly controlled pre-pregnancy, so the first trimester dip made my BP too low).

I now take an ARB + HCTZ (diuretic) and my HTN is controlled. These aren't pregnancy safe, so if I decide to get pregnant again I will switch to metoprolol again. (It's used less in pregnancy but was cleared by my MFM--he said no reason to switch since it controlled my BP well. My internist rarely uses labetalol; it mainly seems to be used in pregnancy, and he handled my HTN meds. MFM said they only took over if I developed superimposed PE again.)

[ellemoon]

I think the max dose of Labetaolol is 2400mg a day (I think). So, you're pretty far from that. But if your BP isn't well controlled on that, then trying something different may be beneficial. You definitely need to get those pressures down.

When I met with the MFM, she told me that I could take the HCTZ (Diuretic) during pregnancy. She said it was thought in the past that it would decrease fluid levels but after studies, it shows no effect on the amniotic fluid. And it will serve as an extra BP medication and help swelling. I was SO Happy to hear that since I take it right now (not pregnant).

Good luck! I hope you figure out the right med/dosage soon.