Chronic hypertension in pregnancy
Chronic hypertension in pregnancy is hypertension predating pregnancy or diagnosed before 20 weeks. It raises the risk of superimposed preeclampsia, growth restriction, and abruption, so management is blood pressure control with pregnancy-safe agents, low-dose aspirin prophylaxis, close surveillance, and switching off teratogenic drugs preconception.
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What this article covers
- Overview
Definition: chronic hypertension in pregnancy is hypertension that predates pregnancy or is diagnosed before 20 weeks of gestation (and persists beyond 12 weeks postpartum).
- Epidemiology
Increasingly common with rising maternal age and obesity.
- Risk factors
Pre-existing essential or secondary hypertension.
- Pathophysiology
Pre-existing vascular disease: established hypertension enters pregnancy with reduced vascular reserve.
- Clinical features
Elevated blood pressure known before or in early pregnancy.
- Differential diagnosis
Gestational hypertension: new-onset hypertension after 20 weeks, lacking the pre-20-week history that defines chronic disease (Gestational hypertension).
- Diagnosis
Establish by hypertension present before pregnancy or before 20 weeks: the diagnostic basis is documented hypertension (140/90 mmHg or higher) predating pregnancy or diagnosed before 20 weeks…
- Management
First-line, control blood pressure with a pregnancy-safe agent (target below 140/90 mmHg), continued through pregnancy: Labetalol 100 to 400 mg PO twice daily.
- Complications
Superimposed preeclampsia and eclampsia. Fetal growth restriction and placental abruption.
- Prognosis
Good with control and surveillance, though risk exceeds normotensive pregnancy.
- Prevention
Preconception optimization and switching off ACE inhibitors and ARBs.
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Related articles
- Gestational hypertension
Gestational hypertension is new hypertension after 20 weeks of pregnancy without proteinuria or other features of preeclampsia. It requires close surveillance because a substantial proportion progresses to preeclampsia; management is blood pressure control with pregnancy-safe agents and timely delivery near term.
- Essential hypertension
Essential (primary) hypertension is chronically elevated blood pressure without an identifiable secondary cause, the overwhelming majority of hypertension. It is a leading modifiable driver of stroke, heart failure, and kidney disease, and management combines lifestyle change with staged pharmacotherapy to a target usually below 130/80 mmHg.
- Secondary hypertension
Secondary hypertension is high blood pressure from an identifiable, often correctable cause, such as primary aldosteronism, renal or renovascular disease, obstructive sleep apnea, or endocrine tumors. It should be suspected with resistant, early-onset, or abrupt hypertension, and identifying the cause can cure or greatly improve control.