The patient should be counselled to avoid pregnancy until her
blood pressure is optimally controlled. A careful history should
be taken and contact made with her general practitioner to
ensure all causes of secondary hypertension have been excluded
and the patient has been appropriately investigated (Table 2).
Once a diagnosis of essential hypertension is made, blood pressure
should be optimally managed. As the women wishes to
conceive you may consider switching her to an alternative agent
(see later section on management of hypertension) as enalopril,
an Angiotensin Converting Enzyme (ACE) inhibitor is contraindicated
in pregnancy due to teratogenesis (increased risk of
cardiovascular and neurological malformations if used in the first
trimester). As the patient is high risk for recurrence of preeclampsia
low dose aspirin should be commenced once
conception occurs. General obstetric advice such as weight loss,
smoking cessation and pre-conceptual folic acid should also be
given.