A Brief Review of the 2009 JSSHP Guidelines for the care and treatment of Pregnancy induced Hypertension

Abstract

We present a brief review of pregnancy induced hypertension (PIH) guidelines provided by the Japan Society for Study of Hypertension in Pregnancy (JSSHP) in 2009. This review aims to compare the Japanese standards of diagnosis, treatment, and management of hypertensive disorders in pregnancy with those of other countries, as well as to present a resource for Japanese clinical studies or case reports published internationally. Hypertension Research In Pregnancy

Oral administration of labetalol might improve not only the blood pressure but also clinical symptoms in Japanese women with gestational hypertension

“…Furthermore, it is desirable for MAP to subsequently be maintained at less than a 20% decreased from that before the start of therapy. 3) In the present study, in 2 patients with GH, MAP fell more than 20% with labetalol administration, but no persistent or transient fetal bradycardia occurred. Thus, the hypotensive action of oral administration of labetalol is relatively weak, though it is safe for the uteroplacental circulation.…”

“…It also stated that labetalol and calcium antagonists should only be used after obtaining informed consent. 3) In 2011, the package inserts for long-acting nifedipine and labetalol were revised as follows: long-acting nifedipine can be administered after 20 weeks of gestation, and labetalol may be used in pregnant women or in those who may be pregnant, only when the advantage of treatment is considered to exceed its risk.…”

“…Oral administration of an antihypertensive for PIH should be started when the BP is more than 160/110 mmHg to prevent maternal organ damage (cerebrovascular, cardiac, or renal damage) by prompt antihypertensive treatment. 3,4) As the BP goal, systolic BP ranges from 140 to 159 mmHg, diastolic BP ranges from 90 to 109 mmHg, and mean arterial pressure (MAP) should be decreased by 15-20%. 3) It recommended that the first-choice antihypertensive oral drugs, methyldopa, hydralazine, labetalol, and longacting nifedipine (only after 20 weeks of gestation), should be used.…”

“…3,4) As the BP goal, systolic BP ranges from 140 to 159 mmHg, diastolic BP ranges from 90 to 109 mmHg, and mean arterial pressure (MAP) should be decreased by 15-20%. 3) It recommended that the first-choice antihypertensive oral drugs, methyldopa, hydralazine, labetalol, and longacting nifedipine (only after 20 weeks of gestation), should be used. For combination therapy, a combination of two drugs with different antihypertensive action mechanisms is desirable, since methyldopa and labetalol are classified as sympatholytic drugs, and hydralazine and longacting nifedipine are classified as vasodilators.…”

Expression of lipocalin-type prostaglandin D synthase in preeclampsia patients: a novel marker for preeclampsia

“…3,4) No definitive therapy other than the interruption of pregnancy has been established, and symptomatic treatment remains the predominant form of managing this syndrome. 2,3,5) Therefore, early diagnosis and prediction of preeclampsia as well as precise measurements of severity are essential for appropriate care. Unfortunately, a reliable biomarker has yet to be identified.…”