Preeclampsia Management: Past, Present & Future

Well, let's go into that a little bit more.

You've mentioned a couple of times that we're not holding our patients to the same criteria that non-pregnant patients are held to when it comes to diagnosis of hypertension.

And specifically, we're talking about the American Heart Association ACC criteria that came out in 2017 that updated the definition of hypertension.

Can you talk a little bit about what the non-pregnant hypertensive guidelines say and why you think we're not using them or should we be using them for pregnancy? Yeah.

So this is, you know, this is a patient population that I don't deal with very often and I have to remind myself, but it was hypertensive disease of stage one is like a 130 systolic over 90 diastolic.

Is that right? And stage two is 140 diastolic.

I think it's- Oh no, 130 over

80 and 140 over

90.

Yeah.

So for us, like I said, our hypertensive disease cutoff is 140 over 90, right? 140 systolic over 90 diastolic.

And it's been that way for many years.

In the 60s and the 70s, there were many attempts to try to broaden this.

There was some data to suggest that diastolic, blood pressures that were elevated in the diastolic range were more predictive of poor outcome than in the systolic range.

But that really hasn't held true.

There were times when we said that, hey, maybe if your baseline systolic blood pressure value increases by 15 millimeters mercury over the pregnancy, that can be predictive.

But then it turns out that the best way, the easiest way, and occasionally the least accurate way of diagnosing a disease is just to make it a simple cutoff.

And we fell on 140 over 90, even though that might not be completely predictive of the disease.

When we talk about the changes in physiology in pregnancy, we expect when somebody becomes pregnant, as early as seven or eight weeks in their pregnancy for them to have a massive reduction in systemic vascular resistance.

So the blood pressure typically drops and then slowly increases throughout the rest of the pregnancy.

But many, many factors can change that, including body habitus.

And so even though by the third trimester, we expect people to kind of have normalized or low normal blood pressures, that isn't always the case.

This comes up so often.

I can see the value of keeping it where it is because I brought this up at a conference and there was a Q&A going on and Dr. Tito was there and Dr. Sabai.

Some heavy

Well, let's go into that a little bit more.

You've mentioned a couple of times that we're not holding our patients to the same criteria that non-pregnant patients are held to when it comes to diagnosis of hypertension.

And specifically, we're talking about the American Heart Association ACC criteria that came out in 2017 that updated the definition of hypertension.

Can you talk a little bit about what the non-pregnant hypertensive guidelines say and why you think we're not using them or should we be using them for pregnancy? Yeah.

So this is, you know, this is a patient population that I don't deal with very often and I have to remind myself, but it was hypertensive disease of stage one is like a 130 systolic over 90 diastolic.

Is that right? And stage two is 140 diastolic.

I think it's- Oh no, 130 over

80 and 140 over

90.

Yeah.

So for us, like I said, our hypertensive disease cutoff is 140 over 90, right? 140 systolic over 90 diastolic.

And it's been that way for many years.

In the 60s and the 70s, there were many attempts to try to broaden this.

There was some data to suggest that diastolic, blood pressures that were elevated in the diastolic range were more predictive of poor outcome than in the systolic range.

But that really hasn't held true.

There were times when we said that, hey, maybe if your baseline systolic blood pressure value increases by 15 millimeters mercury over the pregnancy, that can be predictive.

But then it turns out that the best way, the easiest way, and occasionally the least accurate way of diagnosing a disease is just to make it a simple cutoff.

And we fell on 140 over 90, even though that might not be completely predictive of the disease.

When we talk about the changes in physiology in pregnancy, we expect when somebody becomes pregnant, as early as seven or eight weeks in their pregnancy for them to have a massive reduction in systemic vascular resistance.

So the blood pressure typically drops and then slowly increases throughout the rest of the pregnancy.

But many, many factors can change that, including body habitus.

And so even though by the third trimester, we expect people to kind of have normalized or low normal blood pressures, that isn't always the case.

This comes up so often.

I can see the value of keeping it where it is because I brought this up at a conference and there was a Q&A going on and Dr. Tito was there and Dr. Sabai.

Some heavy