Treatment Guideline Chart
Hypertension in pregnancy is defined as a systolic blood pressure of ≥140 mmHg or a diastolic blood pressure of ≥90 mmHg, or both, based on at least 2 measurements ≥4 hours apart.
Diagnosis of severe hypertension is made when blood pressure is ≥160/110 mmHg.
Measurement should be repeated after 15 minutes for confirmation of severe hypertension.

Hypertension%20in%20pregnancy Patient Education

Patient Education

  • Patient should be advised on the following effects of hypertension in pregnancy and vice versa to plan potential lifestyle and treatment changes before and during pregnancy:
    • Women with preexisting hypertension and TOD should be made aware that pregnancy may exacerbate the condition
    • Chronic hypertension with early proteinuria may increase risk of adverse neonatal outcomes, whether or not preeclampsia occurs
    • Increased risk of fetal loss and deterioration of maternal renal disease if serum creatinine >1.4 mg/dL
    • A tenfold increase in risk of fetal loss in uncontrolled hypertension with impaired renal function during conception as compared to pregnancy with controlled hypertension or without hypertension
    • Risk of developing cardiovascular disease (eg hypertension, ischemic heart disease, heart failure, stroke), metabolic syndrome and chronic or end-stage renal disease in the future is increased in women with hypertensive disorders of pregnancy or puerperium
  • Patient should be informed about the risk of recurrence of hypertension or preeclampsia in the next pregnancy and that preeclampsia is more common in women with chronic hypertension
    • Risk of hypertension recurrence in the next pregnancy is higher with early-onset hypertension in first pregnancy
  • After a hypertensive pregnancy, patient should be counseled regarding a healthy diet and lifestyle and control of risk factors for long-term cardiovascular and metabolic diseases for herself and her child
  • Encourage home BP monitoring for hypertensive women 
    • Self-measured BP identifies nonsustained elevations in BP including masked and white coat hypertension
  • Counsel patient on the long-term perinatal and neonatal complications associated with preeclampsia: Cerebral palsy, low intelligence, visual and hearing disturbances, metabolic problems (eg insulin resistance and diabetes), neonatal hypertension and coronary artery disease

Lifestyle Modification

  • Pregnant women without contraindications should exercise to prevent preeclampsia
    • For patients with well-controlled chronic hypertension who are used to exercising, moderate exercise during pregnancy is recommended
  • Avoid smoking
    • Increases risk of placental abruption in addition to fetal growth restriction
  • Avoid alcohol
    • Excessive consumption may cause or exacerbate maternal hypertension and lead to congenital anomalies
  • Weight reduction is not recommended for management of chronic hypertension in pregnancy
    • It is advised that women with BMI ≥30 kg/m2 should not gain weight of >6.8 kg
    • BMI should be kept within the normal range prior to the next pregnancy in women with previous preeclampsia
  • Limit salt intake in diet 
Editor's Recommendations
Special Reports