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Hypertension in pregnancy

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Updated 2024 ESC guidelines for the evaluation and management of hypertension in pregnancy.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hypertension in pregnancy are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2023), the American Diabetes Association (ADA 2024), the European Society of Cardiology (ESC 2024,2018), the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ 2024), the European Society of ...
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Screening and diagnosis

Indications for screening: as per ESH 2023 guidelines, consider obtaining home BP monitoring as an alternative to conventional office BP measurement to detect new-onset hypertension in patients at risk for preeclampsia without preexisting hypertension.
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Diagnostic investigations

BP measurement: as per ISSHP 2022 guidelines, obtain BP measurement using a standardized technique, including patient's position (sitting, feet flat on the floor), cuff size (large if the mid-upper arm circumference is ≥ 33 cm), Korotkoff V for the DBP, and arm used (both, at least initially).
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More topics in this section

  • Home and ambulatory BP monitoring

  • Evaluation for secondary hypertension

  • Screening for preeclampsia

Medical management

Indications for treatment: as per ISSHP 2022 guidelines, initiate antihypertensive therapy in pregnant patients with hypertension, irrespective of the underlying hypertensive disorder of pregnancy.
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  • BP targets

  • Choice of agent

  • Management of severe hypertension

  • Low-dose aspirin

  • Other agents

Nonpharmacologic interventions

Calcium supplementation: as per SOMANZ 2024 guidelines, assess dietary calcium intake before recommending oral calcium supplementation.
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Therapeutic procedures

Timing of delivery: as per AAFP 2024 guidelines, plan delivery in patients with gestational hypertension or preeclampsia without severe features at 37 weeks of gestation.
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Patient education

Pre-pregnancy counseling
As per HC 2020 guidelines:
Provide preconception counseling in females with pre-pregnancy hypertension to advise on individualized antihypertensive medication management during pregnancy.
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Consider discontinuing ACEIs and ARBs in females planning pregnancy.
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Preventative measures

Physical activity: as per ESC 2024 guidelines, advise low-to-moderate-intensity exercise in all pregnant women without contraindications, in consultation with an obstetrician, to reduce the risk of gestational hypertension and preeclampsia.
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Follow-up and surveillance

Home BP monitoring
As per SOMANZ 2024 guidelines:
Consider obtaining home BP monitoring using a validated BP device, where appropriate, in patients with chronic or gestational hypertension, but not as a substitute for the minimum recommended frequency of antenatal review according to the patient's parity and stage of pregnancy.
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Reassess compliance and technique with home BP monitoring at each review to ensure ongoing suitability.
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More topics in this section

  • Follow-up

  • Postpartum management