Management of new-onset hypertension in pregnancy

Abstract

Hypertensive disorders affect approximately 8–10% of all pregnancies and include pre-eclampsia, gestational hypertension and pre-existing chronic hypertension, which may be primary or secondary. New onset hypertension in pregnancy is defined as a sustained systolic blood pressure (sBP) ≥140 mmHg and/or diastolic blood pressure (dBP) ≥90 mmHg, and severe hypertension diagnosed when sBP ≥160 mmHg and/or dBP ≥110 mmHg. Gestational hypertension and pre-eclampsia are most common, affecting 4.2–7.9% and 1.5–7.7% respectively. Chronic hypertension affects 0.6–2.7% of pregnancies but may be under-reported due to early physiological adaptations in pregnancy lowering blood pressure or unknown preconception blood pressure. New onset hypertension developing at any stage of pregnancy requires a full history, examination, and investigations to delineate an underlying cause, assess for target organ damage and the presence of pre-eclampsia to assign risk. Developing a hypertensive disorder in pregnancy is associated with increased life-long cardiometabolic risk and other cardiovascular risk factors should be minimised to improve a woman's long-term health.