Management of Pregnancy-Induced Hypertension

Classification and Diagnosis

The American College of Cardiology defines gestational hypertension as hypertension that develops after 20 weeks of gestation without proteinuria 4
The European Society of Cardiology defines pre-eclampsia as gestational hypertension with clinically significant proteinuria (≥0.3 g/day in a 24h urine collection or ≥30 mg/mmol urinary creatinine) 4
Pre-existing hypertension plus superimposed gestational hypertension with proteinuria occurs when pre-existing hypertension worsens with protein excretion ≥3 g/day after 20 weeks gestation 4

The American Heart Association recommends initiating treatment at BP ≥140/90 mmHg for women with gestational hypertension, pre-existing hypertension with superimposed gestational hypertension, or hypertension with subclinical organ damage 1, 2
The European Society of Cardiology recommends a target diastolic BP of 85 mmHg and systolic BP between 110-140 mmHg to ensure adequate uteroplacental perfusion 1, 2

The American College of Cardiology recommends oral methyldopa, labetalol, or nifedipine as first-line agents for treating hypertension in pregnancy 1, 2
The European Society of Cardiology recommends hydralazine and prazosin as second or third-line agents for treating hypertension in pregnancy 1, 2

The American Heart Association recommends urgent treatment in a monitored setting for BP ≥170/110 mmHg 1, 2
The European Society of Cardiology recommends first-line agents for severe hypertension, including oral nifedipine, IV labetalol, and IV hydralazine 1, 2

The American College of Obstetricians and Gynecologists recommends inducing delivery in gestational hypertension with proteinuria if adverse conditions are present (visual disturbances, coagulation abnormalities, fetal distress) 5, 6
The European Society of Cardiology recommends delivering women with pre-eclampsia at 37 weeks (and zero days) gestation 1, 2

The American Heart Association recommends lifestyle modifications, regular BP monitoring, and control of metabolic factors after delivery to reduce the risk of hypertension and stroke in later life 1, 2
The European Society of Cardiology recommends annual medical review lifelong for women who had hypertensive disorders of pregnancy 3