[Kidneys, hypertension and pregnancy. II. Hypertension in pregnancy: significance, prognosis, and treatment (author's transl)].

A rise in arterial pressure above 140 mmHg systolic or 85 mmHg diastolic is pathological in pregnant women. Such changes may either reveal chronic hypertension or constitute a purely gestational complication. The persistence or regression of abnormally high BP values 3 months after delivery retrospectively indicates whether the hypertension was chronic or pregnancy-related. When BP values are very high (diastolic above 110 mmHg) the mother is exposed to vascular accidents and the most effective anti-hypertensive drugs are required. In the more common moderate hypertension, both the mother (eclampsia) and the foetus (intra-uterine or neonatal death, low birth-weight) are at risk. The risk is better predicted by proteinuria and hyperuricaemia than by the BP values themselves, and whether anti-hypertensive drugs are warranted is uncertain. Studied comparing patients with treated and untreated moderate hypertension have yielded two valuable results: (1) methyldopa administered to the mother is harmless to the foetus, and (2) abortion during the second trimester of pregnancy is probably prevented when methyldopa is prescribed against chronic hypertension. No study has yet afforded evidence that the use of anti-hypertensive drugs in gestational hypertension benefits the foetus. Further therapeutic trials and a better knowledge of the natural history and mechanisms of hypertension in pregnancy are required before adequate management of this condition can be determined.