gestational hypertension

Gestational hypertension (formerly called pregnancy-induced hypertension) is defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg on two occasions at least 4 hours apart, arising after 20 weeks of gestation in a woman with previously normal blood pressure, in the absence of proteinuria or other features of preeclampsia (thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or new-onset headache/visual disturbances). Pathophysiology is thought to overlap with preeclampsia—abnormal placentation, endothelial dysfunction, and increased vascular resistance—but is generally less severe. Up to 15-25% of women with gestational hypertension progress to preeclampsia, so serial monitoring of blood pressure, urine protein, and symptoms is essential. Classification: mild (<160/110) vs severe (≥160/110), which requires more urgent management. Management includes close outpatient monitoring, blood pressure checks, and fetal surveillance (growth scans, NSTs). Antihypertensives (labetalol, nifedipine, methyldopa) are used if severe (≥160/110) to prevent maternal complications like stroke; ACE inhibitors and ARBs are contraindicated due to fetal renal toxicity. Delivery timing depends on gestational age and severity—generally induced at 37-39 weeks if stable, earlier if severe features develop. Postpartum, blood pressure should normalize within 12 weeks; if hypertension persists beyond this, it suggests chronic hypertension unmasked by pregnancy. Women with gestational hypertension have increased long-term cardiovascular risk (future hypertension, cardiovascular disease) and should be counseled on lifestyle modification and follow-up.