Hypertension in pregnancy.

Hypertension in pregnancy is still a leading cause of morbidity and mortality in mother and fetus. This review of the literature from 1991 to 1992 focuses on research relating to the causes of preeclampsia and the pathogenesis of the marked vasoconstriction so characteristic of this disease. Reports hypothesizing primary roles for endothelial cell dysfunction, aberrations in prostaglandin synthesis, fatty acid and antioxidant metabolism, as well as for dietary calcium deficiency and the renin-angiotensin system are analyzed; articles regarding clinical trials whose origins derive from some of these hypotheses, such as low-dose aspirin and calcium supplementation to prevent preeclampsia, are appraised. The review concludes by examining several controversies regarding management of pregnant women with chronic hypertension, including the proper way to measure blood pressure in pregnancy, the diastolic level at which treatment with antihypertensive medications should commence, and the choice of drugs that are safe and preferable for use during gestation.