GPAtlas🧭 When to suspect
Hypertension complicates up to 1 in 10 pregnancies and remains a leading cause of maternal and perinatal morbidity. Define hypertension in pregnancy as a sustained blood pressure (BP) ≥ 140/90 mmHg; severe hypertension is ≥ 160/110 mmHg. Three patterns matter in primary care: chronic hypertension (present before pregnancy or before 20 weeks, or already on antihypertensives), gestational hypertension (new after 20 weeks, without significant proteinuria), and pre-eclampsia (new hypertension after 20 weeks with proteinuria and/or maternal organ dysfunction).
The pivotal shift to remember is that pre-eclampsia no longer requires proteinuria. New hypertension after 20 weeks plus maternal organ dysfunction (kidney, liver, neurological or haematological) or fetal growth restriction is sufficient to diagnose it. A clean urine dipstick therefore never excludes pre-eclampsia.
The primary-care role is threefold: risk-stratify early and offer aspirin prophylaxis from 12 weeks to those who qualify; recognise and urgently refer new hypertension or pre-eclampsia symptoms after 20 weeks; and provide safe pharmacological management and postnatal follow-up. New hypertension after 20 weeks is assessed in secondary care (maternity), not in primary care alone.
| Pattern | Definition / timing | Key primary-care action |
|---|---|---|
| Chronic hypertension | BP ≥ 140/90 mmHg before pregnancy or before 20 weeks (or already on treatment) | Pre-conception/early review: stop unsafe drugs, switch to a pregnancy-safe agent, start aspirin from 12 weeks, refer to specialist |
| Gestational hypertension | New BP ≥ 140/90 mmHg after 20 weeks, without significant proteinuria | Same-day maternity (secondary-care) assessment; watch closely for evolution into pre-eclampsia |
| Pre-eclampsia | New BP ≥ 140/90 mmHg after 20 weeks plus proteinuria and/or maternal organ dysfunction (renal, hepatic, neurological, haematological) or fetal growth restriction | Urgent maternity assessment / admission – the diagnosis that must never be missed |
| Severe hypertension (any pattern) | BP ≥ 160/110 mmHg | Emergency admission for rapid control, whatever the underlying pattern |
Source: NICE NG133
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