Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 19 peer-reviewed journal articles Updated
Obstetrics and Gynecology · Hypertensive Disorders of Pregnancy

Blood Pressure and Your Pregnancy

At a Glance

Hypertensive disorders of pregnancy, including preeclampsia, require careful monitoring to protect maternal and fetal health. Doctors now recommend treating blood pressure at 140/90 mmHg to reduce severe risks. Postpartum care is essential, as these conditions increase lifetime heart disease risk.

For many, pregnancy is the first time they ever have to think about their blood pressure. While most pregnancies proceed without complication, hypertensive disorders of pregnancy (HDP) are among the most common medical issues during this time. Understanding these conditions isn’t about adding stress; it’s about empowering yourself with the knowledge to protect both your health and your baby’s.

The Four Categories of Pregnancy Hypertension

The American College of Obstetricians and Gynecologists (ACOG) divides these disorders into four main groups based on when the high blood pressure (BP) starts and what other symptoms are present:

  1. Chronic Hypertension: High BP (140/90 mmHg or higher) that was present before you got pregnant or that is discovered before the 20th week of pregnancy [1].
  2. Gestational Hypertension: High BP that starts for the first time after 20 weeks of pregnancy, but without protein in the urine or other signs of organ damage [2].
  3. Preeclampsia: This is a more complex condition where high BP starts after 20 weeks and is accompanied by signs that other organ systems—like the kidneys or liver—are under stress [3][4].
  4. Superimposed Preeclampsia: This occurs when a person with chronic hypertension develops preeclampsia during their pregnancy [5].

Watching for “Severe Features”

If you are diagnosed with preeclampsia, your care team will watch closely for severe features. These are specific signs that the condition is progressing and may require more intensive care or an earlier delivery [6].

Contact your doctor immediately if you experience:

  • Persistent Headache: A headache that doesn’t go away with usual care [7].
  • Visual Changes: Seeing spots, flashes of light, or having blurred vision [7].
  • Upper Abdominal Pain: Specifically “epigastric” pain in the upper right side, which can signal liver stress [7][8].
  • Shortness of Breath: This can be a sign of fluid buildup in the lungs (pulmonary edema) [7].

A New Standard for Treatment

In recent years, the way doctors treat high blood pressure during pregnancy has changed. Based on large studies like the CHAP trial, the standard of care now recommends starting antihypertensive treatment at a threshold of 140/90 mmHg for those with chronic hypertension [1][9].

The goal of this treatment is to keep your blood pressure below 140/90 mmHg, which has been shown to reduce the risk of developing severe preeclampsia without harming the baby’s growth [9][10][11].

CRITICAL WARNING: If you are taking ACE inhibitors or ARBs for chronic hypertension, you must work with your doctor to switch to safer alternatives before or immediately upon becoming pregnant, as these medications can severely harm a developing baby.

Beyond the “Fourth Trimester”

It is important to know that HDP is not just a pregnancy complication; it is a “window” into your future cardiovascular health. Women who have had HDP have a higher lifelong risk for:

  • Chronic Hypertension: Developing permanent high blood pressure later in life [12].
  • Heart Disease & Stroke: An increased risk of heart failure, stroke, and heart attacks [13][14].
  • Kidney Disease: A higher risk of long-term kidney issues [15].

Postpartum follow-up is critical. Your blood pressure should be checked within the first week after delivery, and you should have a dedicated cardiovascular health screening 3 to 12 months after giving birth [16][17]. Maintaining a healthy lifestyle and regular check-ups can significantly lower these long-term risks [18][19].

Common questions in this guide

What are the different types of pregnancy hypertension?
There are four main categories: chronic hypertension present before 20 weeks, gestational hypertension starting after 20 weeks, preeclampsia which involves other organ stress, and superimposed preeclampsia.
At what blood pressure reading will my doctor start treatment during pregnancy?
Current medical guidelines recommend starting blood pressure medication when readings reach 140/90 mmHg. Keeping blood pressure below this level helps reduce the risk of severe preeclampsia without harming the baby's growth.
What are the warning signs of severe preeclampsia?
Warning signs that require immediate medical attention include persistent headaches that do not go away, seeing spots or blurred vision, upper right abdominal pain, and shortness of breath.
Are all blood pressure medications safe to take during pregnancy?
No. Certain medications, specifically ACE inhibitors and ARBs, can severely harm a developing baby. You must work with your doctor to switch to safer alternatives before or immediately upon becoming pregnant.
Does high blood pressure during pregnancy affect my long-term health?
Yes. Having a hypertensive disorder during pregnancy increases your lifelong risk for chronic high blood pressure, heart disease, stroke, and kidney disease. A cardiovascular health screening 3 to 12 months after giving birth is highly recommended.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my blood pressure readings, which specific category of pregnancy hypertension do I fall into?
  2. 2.What is our 'red line' blood pressure number where I need to call the office or go to the hospital immediately?
  3. 3.Since the CHAP trial findings, should we be starting or adjusting my blood pressure medication at the 140/90 threshold?
  4. 4.If I have preeclampsia, what is our plan for monitoring for 'severe features' like liver or kidney changes?
  5. 5.What specific postpartum follow-up do I need to monitor my long-term heart and kidney health?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Update on Preeclampsia and Hypertensive Disorders of Pregnancy.

    Rosenberg EA, Seely EW

    Endocrinology and metabolism clinics of North America 2024; (53(3)):377-389 doi:10.1016/j.ecl.2024.05.012.

    PMID: 39084814
  2. 2

    ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia.

    Obstetrics and gynecology 2019; (133(1)):1 doi:10.1097/AOG.0000000000003018.

    PMID: 30575675
  3. 3

    Hypertensive Disorders of Pregnancy.

    Newman C, Petruzzi V, Ramirez PT, Hobday C

    Methodist DeBakey cardiovascular journal 2024; (20(2)):4-12 doi:10.14797/mdcvj.1305.

    PMID: 38495660
  4. 4

    From pregnancy to renal disease: Understanding preeclampsia.

    Mitchell-Brown F, Pubols J

    Nursing 2020; (50(1)):24-30 doi:10.1097/01.NURSE.0000615068.61059.3e.

    PMID: 31764581
  5. 5

    Hypertensive Disorders of Pregnancy Subtypes and Long-Term Cardiovascular Risk.

    Kwak S, Park CS, Park Y, et al.

    JAMA internal medicine 2026; (186(4)):469-478 doi:10.1001/jamainternmed.2025.7802.

    PMID: 41627823
  6. 6

    Quantifying the additional maternal morbidity in women with preeclampsia with severe features in whom immediate delivery is recommended.

    Jaber S, Jauk VC, Cozzi GD, et al.

    American journal of obstetrics & gynecology MFM 2022; (4(3)):100565 doi:10.1016/j.ajogmf.2022.100565.

    PMID: 35033750
  7. 7

    Update in the Management of Patients with Preeclampsia.

    Dhariwal NK, Lynde GC

    Anesthesiology clinics 2017; (35(1)):95-106 doi:10.1016/j.anclin.2016.09.009.

    PMID: 28131123
  8. 8

    Elevated liver enzymes and adverse outcomes among patients with preeclampsia with severe features.

    Greiner KS, Rincón M, Derrah KL, Burwick RM

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2023; (36(1)):2160627 doi:10.1080/14767058.2022.2160627.

    PMID: 36597834
  9. 9

    Society for Maternal-Fetal Medicine Statement: Antihypertensive therapy for mild chronic hypertension in pregnancy-The Chronic Hypertension and Pregnancy trial.

    American journal of obstetrics and gynecology 2022; (227(2)):B24-B27 doi:10.1016/j.ajog.2022.04.011.

    PMID: 35710594
  10. 10

    Management of blood pressure in pregnancy: new perspectives from the CHAP trial.

    Holliman KD, Lowe V, Nonni G

    Current opinion in obstetrics & gynecology 2023; (35(2)):81-86 doi:10.1097/GCO.0000000000000845.

    PMID: 36912258
  11. 11

    Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association.

    Garovic VD, Dechend R, Easterling T, et al.

    Hypertension (Dallas, Tex. : 1979) 2022; (79(2)):e21-e41 doi:10.1161/HYP.0000000000000208.

    PMID: 34905954
  12. 12

    Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records: A CALIBER Study.

    Leon LJ, McCarthy FP, Direk K, et al.

    Circulation 2019; (140(13)):1050-1060 doi:10.1161/CIRCULATIONAHA.118.038080.

    PMID: 31545680
  13. 13

    Are Preeclampsia and Adverse Obstetrical Outcomes Predictors of Cardiovascular Disease? A Case-Control Study of Women With Heart Disease.

    Sia WW, Pertman SM, Yan RM, Tsuyuki RT

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2019; (41(12)):1760-1767 doi:10.1016/j.jogc.2019.03.023.

    PMID: 31279766
  14. 14

    Pregnancy-Induced Hypertensive Disorder and Risks of Future Ischemic and Nonischemic Heart Failure.

    Mantel Ä, Sandström A, Faxén J, et al.

    JACC. Heart failure 2023; (11(9)):1216-1228 doi:10.1016/j.jchf.2023.03.021.

    PMID: 37178088
  15. 15

    Adverse Pregnancy Outcomes and Long-term Maternal Kidney Disease: A Systematic Review and Meta-analysis.

    Barrett PM, McCarthy FP, Kublickiene K, et al.

    JAMA network open 2020; (3(2)):e1920964 doi:10.1001/jamanetworkopen.2019.20964.

    PMID: 32049292
  16. 16

    Persistent postpartum hypertension 3 months post-delivery among women with hypertensive disorders of pregnancy in Tanzania: A multicenter cohort study.

    Ahmed AA, Willkens MA, Matovelo D, et al.

    Pregnancy hypertension 2024; (35()):51-54 doi:10.1016/j.preghy.2023.12.006.

    PMID: 38176194
  17. 17

    Detection of hypertension and blood pressure phenotypes using ambulatory blood pressure monitoring in women with past hypertensive disorders of pregnancies.

    Pant A, Mukherjee S, Watts M, et al.

    Pregnancy hypertension 2025; (39()):101193 doi:10.1016/j.preghy.2025.101193.

    PMID: 39837047
  18. 18

    Healthy lifestyle reduces cardiovascular risk in women with genetic predisposition to hypertensive disorders of pregnancy.

    Jung SH, Kim H, Jung YM, et al.

    Nature communications 2025; (16(1)):1463 doi:10.1038/s41467-025-56107-2.

    PMID: 39920105
  19. 19

    Cardiovascular Disease-Related Emergency Department Visits and Hospitalization among Women with Hypertensive Disorders of Pregnancy.

    Avorgbedor F, McCoy TP, Gondwe KW, et al.

    American journal of preventive medicine 2023; (64(5)):686-694 doi:10.1016/j.amepre.2023.01.004.

    PMID: 36863895

This page provides information on pregnancy-related blood pressure conditions for educational purposes only. It does not replace professional medical advice. Always consult your obstetrician or healthcare provider regarding your specific symptoms and treatment.

Get notified when new evidence is published on hypertensive disorder.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.