Chronic hypertension and gestational hypertension — Rapid

Synopsis

Distinguish pre-existing hypertension from new pregnancy-associated hypertension, recognise progression towards pre-eclampsia, and organise effective maternal treatment with appropriate fetal and postnatal surveillance.

Hypertension means systolic pressure at least 140 mmHg or diastolic pressure at least 90 mmHg; either component can establish an abnormal result.
Hypertension present before pregnancy, at booking or before 20 weeks is usually chronic; new hypertension after 20 weeks without pre-eclampsia features is gestational.
For sustained non-severe hypertension, offer medication at 140/90 mmHg or higher and aim for approximately 135/85 mmHg on treatment.
Consider labetalol, use nifedipine if unsuitable, and methyldopa if both are unsuitable, incorporating previous response, contraindications and patient preference.
Chronic hypertension warrants aspirin 75–150 mg orally daily from 12 weeks until birth unless contraindicated.
Never use absent proteinuria alone to rule out pre-eclampsia; maternal organ dysfunction or uteroplacental dysfunction can fulfil the diagnosis.
Avoid routine birth before 37 weeks for otherwise uncomplicated hypertension below 160/110 mmHg; agree timing after 37 weeks with the senior obstetric team.
Measure blood pressure after birth, stop methyldopa within two days, and arrange medication review and a six-to-eight-week medical assessment.

Key red flags

Severe headache, flashing lights, epigastric pain, new breathlessness or reduced fetal movements require immediate maternity review for pre-eclampsia or placental compromise.

Any blood pressure at or above 160 systolic or 110 diastolic needs urgent reassessment and escalation; do not wait for a routine follow-up appointment.

Oliguria, falling platelets, rising creatinine or transaminases, pulmonary oedema or a seizure signifies possible multisystem disease.

Investigation priorities

Repeated standardised blood pressureFirst step

Confirm persistence and identify a severe reading that changes urgency.

Management branches

Initial assessmentClassify hypertension and assess current risk

A raised antenatal blood pressure is confirmed on appropriate repeat measurement.

Review prior readings, gestation, medication exposure, secondary causes and previous hypertensive pregnancy complications.
Ask actively about neurological, respiratory, upper abdominal and fetal-movement symptoms, and obtain urine and baseline blood tests.
Refer newly identified gestational hypertension for specialist assessment and provide an explicit review interval and emergency contact route.

Key medicines

Labetalol oral maintenanceA product-supported starting regimen is 100 mg orally twice daily, increased according to response; outpatient increments may be 100 mg twice daily at weekly intervals, with faster supervised inpatient titration when necessary.Avoid with asthma or significant bradycardia, heart block or decompensated heart failure; assess maternal symptoms and neonatal beta-blockade risk.

Nifedipine prolonged releaseOne product-specific maintenance option is Adalat LA 30 mg orally once daily, titrated by the maternity prescriber to measured response within that product's authorised range.Specify brand and release formulation, swallow whole, assess headache or hypotension and check current pregnancy wording and drug interactions.

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