Pregnancy-related hypertension and postpartum sequelae in special conditions - unraveling a multifaceted challenge

Abstract

Background. Hypertension disorders during pregnancy are a leading cause of maternal and fetal morbidity and mortality globally. It becomes extremely challenging to manage a pregnancy in woman with preexisting hypertension and other comorbidities like chronic kidney disease, history of stroke and others. Objective(s). This paper aims to present a clinical case that lies at the crossroads of cardiology, obstetrics, nephrology, and neurology, interpreted in the context of current guidelines and evidence-based studies. Materials and methods. Based on a real clinical case, we conducted a review of current scientific literature (aa.2019-2025) and tailored the management of a pregnant patient diagnosed with preexisting hypertension, chronic kidney disease, and a history of recurrent cerebrovascular events, and persistence of hypertension in postpartum period. Results. An 18-year-old woman, transferred after emergency cesarean section at 32 weeks for preeclampsia, was admitted to the Cardiology Institute for antihypertensive treatment adjustment. She had hypertension since age 10, two ischemic strokes with right hemiparesis and dysarthria, and chronic kidney disease. Chronic treatment included Lisinopril and Indapamide (Captopril as needed); during pregnancy: Methyldopa (Nifedipine as needed). On admission: BP 145/90 mmHg, normal ECG, preserved systolic function (69%), mild left ventricular hypertrophy, elevated LDL (6.05 mmol/L) and triglycerides (2.36 mmol/L), no renal artery stenosis on Doppler. Conclusion(s). Management required the use of drugs with limited safety data in lactation (torasemid, valsartan, statins). This case highlights the need to tailor treatment before, during, and after pregnancy, focusing on both maternal and fetal safety, along with appropriate lactation counseling.