Hypertension Management Strategies in Pregnancy

Hypertensive disorders affect up to 10 per cent of pregnancies worldwide and encompass chronic hypertension, gestational hypertension and pre-eclampsia. Effective management aims to reduce maternal morbidity—such as stroke, heart failure and renal injury—and adverse perinatal outcomes including preterm birth, fetal growth restriction and stillbirth, while safeguarding fetal development. Non-pharmacological measures such as dietary modification, salt restriction and regular antenatal surveillance represent first-line interventions, particularly in cases of mild blood pressure elevation. Low-dose aspirin and calcium supplementation are recommended for women at high risk of pre-eclampsia. When pharmacotherapy becomes necessary, antihypertensive agents are selected according to severity: methyldopa, labetalol and nifedipine are widely used in moderate hypertension, whereas intravenous hydralazine, labetalol or nicardipine may be reserved for acute severe presentations. Tailoring treatment to gestational age, comorbidities and local resources is essential, and close postnatal follow-up facilitates cardiovascular risk reduction in mothers.

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Hypertension Management Strategies in Pregnancy publication trend

The graph below shows the total number of articles in hypertension management strategies in pregnancy across all publications each year (not limited to Nature Index journals).

Technical terms

Gestational hypertension: New-onset hypertension occurring after 20 weeks of gestation in the absence of proteinuria.

Preeclampsia: Pregnancy-associated hypertension with proteinuria or signs of end-organ dysfunction developing after 20 weeks’ gestation.

Severe hypertension: Systolic blood pressure ≥160 mm Hg or diastolic pressure ≥110 mm Hg requiring urgent therapy to prevent maternal and fetal complications.

Network meta-analysis: A statistical technique allowing comparison of multiple treatments across different trials in a single, coherent framework.

Systolic/diastolic blood pressure: The peak (systolic) and trough (diastolic) arterial pressures measured during the cardiac cycle.

References

1. Oral antihypertensive treatment during pregnancy: a systematic review and network meta-analysis. American Journal of Obstetrics and Gynecology (2025).
2. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. The Lancet (2019).
3. Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis. Frontiers in Pharmacology (2023).