Management of a Pregnant Woman With Fibromuscular Dysplasia

Berra, Elena;Dominiczak, Anna F.;Touyz, Rhian M.;Pierard, Sophie;Persu, Alexandre;et.al.
(2018) Hypertension — Vol. 71, n° 4, p. 540-547 (2018)

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INTRODUCTION: A 39-year-old woman of Moroccan origin presented to the Cardiology Department with high blood pressure, with systolic blood pressure repeatedly measured at 170 mm Hg in the office. She was 10 days pregnant. Her treatment included nebivolol 5 mg and barnidipine 10 mg. Her medical history included migraines, an early miscarriage in 2001, and a second pregnancy with delivery at 27 weeks for preeclampsia in December 2014. At post-partum, she had received amlodipine, and then bisoprolol at another hospital. In September 2015, she had consulted at a third hospital for persistent hypertension with moderate to high blood pressure (systolic blood pressure: 170–190 mm Hg). Blood pressure was measured at 170/80 mm Hg in the office. Cardiac test results were normal. The physician concluded that the patient experienced chronic, rather than pregnancy-related hypertension, and replaced bisoprolol 5 mg with nebivolol 5 mg; barnidipine 10 mg was maintained, and the patient was asked to adhere to the therapeutic regimen. Despite mentioning that the hypertension was likely essential, he ordered an etiologic work-up. Renal function was normal (plasma creatinine: 58 μmol/L; estimated glomerular filtration rate: 100 mL/min per 1.73 m2). Urinary analysis revealed a mildly increased proteinuria of one-half gram per 24 hours. Urinary metanephrines were in the normal range, and the renal duplex study suggested a differential diagnosis of right renal artery stenosis and an arterial loop. [...]
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Berra, E., Dominiczak, A. F., Touyz, R. M., Pierard, S., Hammer, F., Rossi, G. P., Micali, R. G., Staessen, J. A., Bursztyn, M., Kahan, T., & Persu, A. (2018). Management of a Pregnant Woman With Fibromuscular Dysplasia. Hypertension, 71(4), 540-547. https://doi.org/10.1161/hypertensionaha.118.10819 (Original work published 2018)