7 - HYPERTENSION: ENQUIRIES, TRIALS AND RECOMMENDATIONS

Summary

Hypertension associated with proteinuria occurs in pre-eclampsia, which can progress to eclampsia (convulsions) and is a major cause of maternal death globally. CEMD Reports reminded doctors that high blood pressure may have other, much rarer, causes. Early diagnosis is important but in the 1950s signs of pre-eclampsia were sometimes taken lightly, allowing eclampsia to occur. The 1979-81 Report recommended that each region should have a specialist team to advise about preventing respiratory and clotting complications. Adherence to guidelines required a major culture shift. Deaths from these complications almost disappeared and by the year 2000 the main cause of death was brain haemorrhage. The Report emphasised the need for prompt administration of antihypertensive drugs. In 1995 a controlled trial showed that magnesium sulphate, the treatment favoured in the USA, was more effective than UK treatments for eclampsia. In 2002 the MAGPIE trial, led by Prof Lelia Duley in Oxford and involving 10,000 women in 33 countries, showed that it is also effective in pre-eclampsia. The rate of fits has fallen and, since 2010, the number of deaths has been in single figures.