Tx of hypertension in pregnant/trying to conceive patients

Physician Opinions

Of the drugs listed, the first line medication for treating hypertension in pregnancy would be methyldopa.  However, it causes bradycardia and this would be a concern in this case (In the clinic, I would try it and monitor responsiveness, as her heart rate is not too low to start with).  Diasoxide was used for hypertensive emergencies and it is now obsolete plus it causes hyperglycemia, which would be a problem in this case.  Hydralazine could theoretically be used as monotherapy in pregnant patients with hypertension; however, it will cause reflex tachycardia and fluid retention; therefore, long-term treatment would require the addition of methyldopa or a related sympatholythic agent.  Labetalol perhaps is the best choice, with the caveat that it would block both beta1 and beta2 receptors and it could delay recovery from hypoglycemia (although this would be more of a problem in an insulin-dependent diabetic).  Verapamil would not be a good choice given the bradycardia.

Treating hypertension in early pregnancy/trying to conceive. He said he would never give hydrazine as an RX/pill/routine medication in the quiz situation, even aware of bradycardia at 59. The OB noted if patient was unstable possibly give one-time hydralazine IV in a controlled hospital setting, but he would have selected labetelol for that further than the quiz scenario. He also said that the risk of AV block was not an issue at a pulse of 59, and he would still give methyldopa. He also noted that the risk of complications from reflex tachycardia are far more detrimental to the mother and fetus than than the known safety of methydopa. He noted that the risk of ventricular arrhythmias from intentionally inducing reflex tachycardia was far more detrimental because of the arryhtmias and the potential for unstable blood pressure in that situation, which should be avoided always. He lastly noted that a beta-blocker (like labetelol) may cause further bradycardia, but that is why methydopa is the best answer - the sympatholtic would slow the sympathetic response, but would not target nodal cells in the same way that beta-blockers would. He again noted that hydralazine should never be given in the stated situation.

Calcium Channel Blockers in a Nutshell

George Washington died of hypovolemic shock

George Washington died of hypovolemic shock

George Washington died due to being “de-sanguinated” in the parlance of the day. To explain, it is December, 1799, and Washington was on his plantation at Mt. Vernon and had been caught in a storm while riding and got sick. The sickness was a throat infection and caused him to have a fever. To treat the fever he was bled by means of venesection. Most doctors through the late 19th Century operated based on the theory of the humors of the body. It was thought that the body contained four humors. These were black bile, yellow bile, phlegm, and blood. When the body was in balance, you were healthy. When you were sick something had caused the body to be out of balance through overproduction or underproduction of one of the biles. Since the heat of the body is carried by the blood, too much heat was believed to be caused by too much blood. A doctor treated this by cutting a vein using a lancet, fleam, or scarificator. He then got a “copious” flow of blood and drained a pint or so a day until the body temperature lowered. They thought the body contained much more blood than it does. The temperature will come down but the body is dehydrated and the patient dies. That is what happened to Washington.