Now this is something i know about as i suffered with it when i was pregnant with my daughter. I myself thought it was more of “white coat” syndrome, ie i knew my blood pressure was on the end of normal before hence i got stressed about having my blood pressure done and therefore had increased blood pressure!

I found a good article from patient UK  which describes what exactly is termed ” hypertension in pregnancy” and what it means and how it can be managed.

• Chronic hypertension affects 1 to 5% of pregnancies.²
• Pregnancy induced hypertension (Gestational Hypertension) affects 5 to 10% of all pregnancies. It is more common in first pregnancies (up to 25%).²

• Hypertension is diagnosed if systolic BP is greater than or equal to 140 mmHg or diastolic BP is greater than or equal to 90 mmHg.
• Most women will be asymptomatic and so routine monitoring of blood pressure and urine for proteinuria. The frequency of monitoring should be determined by local guidelines and the NICE guidelines for routine antenatal care.³
• The symptoms for pre-eclampsia and eclampsia are discussed in a separate article.

• Secondary hypertension (e.g. phaeochromocytoma which may cause sudden death in pregnancy) is rare in pregnancy.
• Other gastrointestinal or renal disorders (e.g. pancreatitis, appendicitis, glomerulonephritis)
• Acute fatty liver of pregnancy
• Systemic lupus erythematosus
• Autoimmune thrombocytopenia purpura
• Encephalitis
• Cerebral venous thrombosis
• Cerebral haemorrhage

• Urinalysis for proteinuria; send urine for culture and sensitivities
• Initial blood tests include full blood count, urea and electrolytes, serum urate and liver function tests – these are usually done in secondary care.
• Fetal monitoring
• Investigations as indicated for possible secondary hypertension or in consideration of differential diagnoses

• Women with pre-existing hypertension or a booking diastolic blood pressure of 90 mmHg or more should be referred early in pregnancy for specialist care.
• Women with new proteinuria without hypertension after 20 weeks:
  • 1 on dipstick: repeat pre-eclampsia assessment in the community within 1 week
  • 2 or more on dipstick: refer for hospital assessment within 48 hours
  • 1 or more on dipstick with epigastric pain, vomiting, headache, visual disturbances, reduced fetal movements, or small for gestational age infant: refer for same-day hospital assessment.
• Women with new hypertension without proteinuria after 20 weeks:
  • Diastolic BP 90-99 mmHg: refer for hospital assessment within 48 hours
  • Diastolic BP 90-99 mmHg with epigastric pain, vomiting, headache, visual disturbances, reduced fetal movements, or small for gestational age infant: refer for same-day hospital assessment
  • Diastolic BP 100 mmHg or greater: refer for same-day hospital assessment
  • Systolic BP 160-169 mmHg: refer for same day hospital assessment (even if diastolic below 90 mmHg)
  • Systolic BP 170 mmHg or greater: arrange immediate admission for treatment of systolic BP (even if diastolic pressure is below 90 mmHg
• Women with new hypertension and new proteinuria after 20 weeks:
  • Diastolic BP 90 mmHg or greater and new proteinuria 1 or more on dipstick: refer for same-day hospital assessment
  • Diastolic BP 110 mmHg or greater and new proteinuria 1 or more on dipstick: arrange immediate admission
  • Systolic BP 160-169 mmHg and new proteinuria 1 or more on dipstick: refer for same-day hospital assessment (even if diastolic pressure is less than 90 mmHg)
  • Systolic BP 170 mmHg or greater and new proteinuria 1 or more on dipstick: arrange immediate admission for treatment of systolic BP (even if diastolic pressure is less than 90 mmHg)
  • Diastolic BP 90 mmHg or greater and new proteinuria 1 or more on dipstick and epigastric pain, vomiting, headache, visual disturbances, reduced fetal movements, or small for gestational age infant: arrange immediate admission

• All pregnant women should receive antenatal education so that they are aware of the symptoms associated with pre-eclampsia, its importance, and the need to obtain medical advice.

• Pregnant women with chronic hypertension are at increased risk of pre-eclampsia and placental abruption.

• Hypertensive diseases of pregnancy remains the second leading cause of direct maternal deaths in the UK.
• Most women with pre-existing mild to moderate hypertension (BP less than 160/110 mmHg) are at low risk of perinatal complications.¹
• The risk of complications (e.g. pre-eclampsia, placental abruption, impaired fetal growth and premature birth) are increased in severe hypertension1.
• Gestational hypertension: similar risks to normotensive women, but 40% of those presenting before 34 weeks’ gestation will go on to develop pre-eclampsia.
• Hypertension and/or proteinuria is the leading single identifiable risk factor in pregnancy associated with stillbirth.

• Low dose aspirin: not used routinely, but may be indicated in those with history of early onset pre-eclampsia in a previous pregnancy.
• Calcium supplementation: appears to reduce the risk of high blood pressure in pregnancy, particularly for women at high risk of gestational hypertension and in communities with low-dietary calcium intake.⁸

1. Hypertension in pregnancy, Clinical Knowledge Summaries (2006)
2. Magee LA, Ornstein MP, von Dadelszen P; Fortnightly review: management of hypertension in pregnancy. BMJ. 1999 May 15;318(7194):1332-6.
3. Antenatal care – Routine care for the healthy pregnant woman, NICE Clinical guidance (2003)
4. Abalos E, Duley L, Steyn DW, et al; Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD002252. [abstract]
5. Magee LA; Treating hypertension in women of child-bearing age and during pregnancy. Drug Saf. 2001;24(6):457-74. [abstract]
6. Magee LA, Cham C, Waterman EJ, et al; Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003 Oct 25;327(7421):955-60. [abstract]
7. Magee LA; Drugs in pregnancy. Antihypertensives. Best Pract Res Clin Obstet Gynaecol. 2001 Dec;15(6):827-45. [abstract]
8. Hofmeyr GJ, Atallah AN, Duley L; Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2006 Jul 19;3:CD001059. [abstract]

Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
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Last Updated: 28 Jun 2007
Review Date: 27 Jun 2009