Differential Diagnosis
Hypertension in Pregnancy_Differential DiganosisThe period in gestation when hypertension first occurs is useful in determining the correct diagnosis. A high BP prior to 20 weeks of gestation usually favors the diagnosis of chronic hypertension (either essential or secondary). Hypertension that occurs at mid-pregnancy (20-28 weeks) may be due to either early preeclampsia (rare <24 weeks), transient hypertension, or chronic hypertension. High BP later in pregnancy may be due to a normal third-trimester rise in the BP or when superimposed preeclampsia occurs. Pain and anxiety must also be ruled out when treating hypertension in pregnancy.
Other clinical syndromes similar in presentation to preeclampsia are:
- Acute fatty liver of pregnancy
- Systemic lupus erythematosus (SLE)
- Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (TTP-HUS)
Consider the following secondary causes of hypertension in women with age <35 years, obesity, severe or resistant hypertension, no family history of hypertension, or laboratory findings early in pregnancy of albuminuria, increased creatinine, or hypokalemia:
- Chronic kidney disease
- Cushing’s disease
- Hyper- or hypothyroidism
- Hypercalcemia
- Medication use (antidepressants, herbal substances, steroids, sympathomimetics)
- Obstructive sleep apnea
- Pheochromocytoma
- Primary hyperaldosteronism
- Renovascular hypertension