CHRONIC HYPERTENSION WITH

OR WITHOUT SUPERIMPOSED

PREECLAMPSIA

A   35-year-old multigravida    is  seen    in  the outpatient  prenatal    clinic  for her

first   prenatal    visit.  She is  at  12  weeks’  gestation   with    a   BP  of  155/95  mm

Hg. Chronic hypertension    was diagnosed   five    years   ago for which   she has

been    treated with    oral    nifedipine. A   spot    urine   dipstick    protein is  2+. A

recent  24  h   urine   collection  showed  1.2 g   of  protein and a   creatinine

clearance   of  85  ml/min. Serum   creatinine  is  1.2 mg/dl.  She has no

complaints  of  headache    or  visual  changes.