Gestational Hypertension Management

Definition and Diagnosis

The American College of Cardiology defines gestational hypertension as blood pressure ≥140/90 mmHg that appears after 20 weeks of gestation and generally resolves within 42 days postpartum 3
Approximately one quarter of gestational hypertension cases progress to preeclampsia, especially those diagnosed before 34 weeks of gestation 1
Diagnosis should be based on at least two elevated blood pressure readings on separate occasions 3

Blood pressure ≥160/110 mmHg requires urgent treatment in a monitored setting; acceptable agents include oral nifedipine, labetalol, or intravenous hydralazine 4, 5
For blood pressures consistently ≥140/90 mmHg in the clinic (or ≥135/85 mmHg at home), treatment is recommended with a goal diastolic pressure of 85 mmHg and systolic pressure between 110-140 mmHg 4, 2
First-line acceptable agents include methyldopa, labetalol, oxprenolol, and nifedipine 4, 2

Regular clinical evaluation, including assessment for clonus 1, 6
Urine analysis at each visit to detect proteinuria 1
Laboratory tests (hemoglobin, platelet count, liver enzymes, uric acid, and creatinine) at least at 28 and 34 weeks of gestation 1

Evaluation of fetal well-being with ultrasound from 26 weeks of gestation 1, 2
Subsequent evaluations every 2-4 weeks if fetal biometry is normal 1
More frequent monitoring in the presence of suspected fetal growth restriction 1, 2

Delivery can be delayed until 39+6 weeks if blood pressure can be controlled, fetal monitoring is reassuring, and preeclampsia has not developed 1, 2
A large retrospective study concluded that the optimal time for delivery is between 38-39 weeks, but this needs clarification with future randomized trials 1

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