Hypertension is the most common problem arising during pregnancy complicating up to 15% of all pregnancies. Definitions have been derived to identify different groups of women for whom the outcomes vary widely, and many definitions were originally designed to aid the researcher rather than the clinician. Untreated severe hypertension either pre-existing or new-onset carries increased risks to both mother and fetus, but in milder disease the benefits of treatment to mother and fetus are less clear. Treatment of moderate pre-existing and new-onset hypertension can reduce the need for admission to hospital antenatally and progression to severe hypertension, but has little impact on progression to pre-eclampsia in either group. Maternal therapy confers little advantage to the fetus in women with pre-existing hypertension, and only marginal improvements in rates of respiratory distress syndrome in women with new-onset pre-eclampsia. Labetalol and methyldopa both appear to be safe and well tolerated. Vigilance for progression to pre-eclampsia and timely delivery are of paramount importance.
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