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.
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What this article covers
- Overview
Definition: gestational hypertension is new-onset hypertension (140/90 mmHg or higher) after 20 weeks of gestation, without proteinuria or the other features that define preeclampsia.
- Epidemiology
A common hypertensive disorder of pregnancy.
- Risk factors
Nulliparity and extremes of maternal age.
- Pathophysiology
Pregnancy-related vascular maladaptation: abnormal cardiovascular and placental adaptation raises blood pressure.
- Clinical features
Elevated blood pressure without symptoms in most.
- Differential diagnosis
Preeclampsia: hypertension after 20 weeks accompanied by proteinuria or end-organ features such as thrombocytopenia, elevated liver enzymes, or renal impairment, distinguished from gestational…
- Diagnosis
Establish by new hypertension at or after 20 weeks without proteinuria or preeclampsia features: the diagnostic basis is a blood pressure of 140/90 mmHg or higher on at least two occasions after 20…
- Management
First-line, control sustained hypertension with pregnancy-safe agents, continued through pregnancy: Labetalol 100 to 400 mg PO twice daily.
- Complications
Progression to preeclampsia and eclampsia.
- Prognosis
Usually resolves postpartum. Higher lifetime cardiovascular and hypertension risk for the mother.
- Prevention
Low-dose aspirin (81 mg PO daily) started before 16 weeks in women at high risk of preeclampsia, continued until delivery.
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Related articles
- 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.
- Hypertensive emergency
Hypertensive emergency is severe hypertension (usually above 180/120 mmHg) with acute target-organ damage such as encephalopathy, stroke, acute heart failure, myocardial ischemia, aortic dissection, or acute kidney injury. It requires controlled intravenous blood pressure reduction, with the target and pace determined by the specific end-organ involved.
- 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.