Hypertension in Pregnancy: Diagnosis and Management

Diagnostic Criteria

The American College of Cardiology defines hypertension in pregnancy as blood pressure ≥140/90 mmHg confirmed on repeated measurements, with severe hypertension being ≥160/110 mmHg, requiring treatment within 15 minutes to prevent stroke 1, 2
Hypertension is diagnosed when systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, confirmed on at least 2 separate occasions, according to the European Society of Cardiology 1, 2
Severe hypertension is defined as systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg, requiring confirmation within 15 minutes, as recommended by the American Heart Association 1, 2

The European Society of Cardiology recommends that women with symptoms such as visual disturbances, severe persistent headache, upper abdominal pain, sudden swelling of face, hands, or feet, shortness of breath, or decreased urine output seek immediate medical attention, as these may indicate preeclampsia with severe features 3, 4, 5

The American College of Obstetricians and Gynecologists recommends that blood pressure be repeated to confirm true hypertension rather than a single elevated reading, and that for severe hypertension, confirmation should occur within 15 minutes and treatment initiated urgently in a monitored setting 1, 2, 3, 6
Antihypertensive medication is initiated at BP ≥140/90 mmHg for women with gestational hypertension, preeclampsia, or hypertension with organ damage, with a target blood pressure of diastolic around 85 mmHg and systolic 110-140 mmHg, as recommended by the European Society of Cardiology 3, 4, 7
The American Heart Association recommends oral methyldopa, labetalol, or nifedipine as first-line agents, and IV labetalol, oral nifedipine, or IV hydralazine for severe hypertension requiring urgent treatment 3, 6

The American College of Cardiology recommends that women with transient gestational hypertension require careful follow-up given the 40% progression risk, and that regular prenatal visits with blood pressure checks at each visit are essential 1, 2, 7
The European Society of Cardiology recommends screening for proteinuria if BP reaches ≥140/90 mmHg, as approximately 25% of gestational hypertension cases progress to preeclampsia 7

The American Heart Association recommends that blood pressure be checked at 6 weeks postpartum, and women with persistent hypertension or proteinuria require specialist referral, and that women who experienced hypertensive disorders of pregnancy have increased long-term cardiovascular risk and require annual medical review lifelong 3, 5, 6