Management of hypertensive disorders in pregnancy

Hypertensive disorders of pregnancy (HDP) are rising in incidence and are associated with significant adverse maternal and fetal outcomes. The purpose of the review is to synthesize the currently available evidence surrounding the diagnosis, management, and prevention of HDP to best inform clinical practice.

The timing and threshold for antihypertensive initiation remain controversial, but recent evidence supports the treatment of chronic hypertension targeted to a blood pressure (BP) of less than 140/90 mmHg. Whether to extend this recommendation to other HDP remains a point of controversy and future research. Diagnostic criteria for HDP, particularly for pre-eclampsia, are expanding to include placental products like circulating soluble fms-like tyrosine kinase-1 for risk-based stratification. The postpartum period is increasingly recognized as a critical window for enhanced focus and BP management with the long-term goal of reducing cardiovascular risk. Proposed strategies include lower BP treatment thresholds and postpartum hypertension referral clinics, but many gaps in evidence remain.

While perinatal risks and available treatment strategies for HDP are well-established, significant gaps in evidence remain, particularly regarding the optimal thresholds for antihypertensive intervention and the postpartum management strategies needed to mitigate long-term maternal adverse health outcomes.