All patients with a sustained blood pressure of 140/90 or greater and any symptoms that may be secondary to hypertension should be hospitalized. Patients with severe hypertension whose blood pressure is greater than 140/90, and who have epigastric or liver tenderness, visual disturbance, or severe headache are managed in the same way as patients with eclampsia, with administration of magnesium sulfate,12 antihypertensives as needed, and delivery of the fetus. The dose of intravenous magnesium sulfate is 4 to 6 g over 15 min followed by intravenous infusion of 1 to 2 g/h. Reflexes and serum magnesium levels should be followed to avoid neuromuscular depression. Angiotensin-converting enzyme (ACE) inhibitors should never be used because of fetal side effects. Table 10.1:5. lists pharmacologic agents for the treatment of hypertension in preeclampsia and eclampsia.
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