Hypertension and the obstetrician-gynecologist.

Hypertension is a major risk factor for cardiovascular-related morbidity and death. Antihypertensive therapy markedly reduces the risk caused by elevated blood pressure. Earlier treatment of hypertensive patients should reduce deaths and morbidity even further. The obstetrician-gynecologist has the opportunity and responsibility to identify hypertensive patients early in the course of their disease. He must also confront the problem of elevated blood pressure associated with the use of oral contraceptives. In addition to its impact on the general population, chronic hypertension presents special problems during pregnancy. Pregnant women with elevated blood pressure have an increased fetal mortality rate and develop pre-eclampsia more frequently and earlier than nonhypertensive women. Antihypertensive treatment possibly increases fetal survival; when used appropriately, it definitely does not decrease fetal salvage. The appropriate use of antihypertensive therapy during pregnancy requires an understanding of the mechanism of action of these agents and recognition of side effects, especially those important during pregnancy.

Renal arteriography in the evaluation of unexplained hypertension in children and adolescents.

Arteriography demonstrated renal artery stenosis in 24% of 101 selected patients whose hypertension was first diagnosed before the age of 20 years. Arteriographic findings were normal in 58%. The prevalence of RAS was greater in the younger than in the older age groups. An abdominal bruit and urographic abnormalities were frequently observed in association with RAS. Adequate follow-up information was available for 16 patients who underwent vascular repair or nephrectomy for RAS. In 14 of the 16, the hypertension was eliminated (81%) or definitely reduced (6%).