Hypertension in Pregnancy

Key points

• Hypertension in pregnancy = BP 140/90 mmHg or higher (the old 'rise from booking' criterion is no longer used). Chronic hypertension: present before pregnancy or before 20 weeks. Gestational hypertension: new hypertension after 20 weeks without proteinuria.
• Pre-eclampsia = new hypertension after 20 weeks plus proteinuria (PCR 30 mg/mmol or more, or ACR 8 mg/mmol or more) or other maternal organ / uteroplacental dysfunction.
• Treatment (NG133): offer antihypertensives if BP is sustained at 140/90 or higher. First-line labetalol; nifedipine if labetalol is unsuitable; methyldopa if both are unsuitable. Stop ACE-inhibitors/ARBs. Aim for a target BP of 135/85 mmHg.
• Aspirin 75-150 mg once daily from 12 weeks until birth for women at high risk of pre-eclampsia (previous hypertensive disease in pregnancy, CKD, autoimmune disease e.g. SLE/antiphospholipid, type 1 or 2 diabetes, chronic hypertension) or with more than one moderate risk factor.
• Offer PlGF-based testing to help rule out pre-eclampsia between 20 and 35-36 weeks if suspected. In normal pregnancy BP falls in the first trimester (particularly diastolic) then returns to baseline by term.

Decision points in this pathway

• Hypertension before pregnancy or >140/90 mmHg before 20 weeks gestation?
• Proteinuria present (>0.3 g/24 hours)?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.