Practice Guidelines

Managing Chronic Hypertension in Pregnant Women: ACOG Releases Updated Practice Bulletin


Am Fam Physician. 2019 Dec 15;100(12):782-783.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Medical treatment of chronic hypertension in pregnancy, that is, hypertension present before 20 weeks' gestation, is recommended at 160 mm Hg systolic or 110 mm Hg diastolic with labetalol or extended-release nifedipine, treating to 120 to 159 mm Hg systolic and 80 to 109 mm Hg diastolic.

• The decision of whether to treat chronic hypertension at lower blood pressure levels should be based on a discussion with the patient as well as the presence of comorbid conditions that might warrant lower blood pressure.

• Low-dose aspirin is recommended in patients with chronic hypertension in pregnancy from between 12 and 28 weeks' gestation to delivery.

• Without other indications, pregnant women with chronic hypertension should not be induced for delivery before 37 weeks' gestation.

From the AFP Editors

In pregnancy, chronic hypertension is defined as hypertension diagnosed before 20 weeks' gestation. Up to 1.5% of pregnant women have chronic hypertension, which can result in harm to the mother and infant. The rates of chronic hypertension are increasing and are predicted to continue because of obesity and older maternal age. Superimposed preeclampsia, the development of preeclampsia in a patient with chronic hypertension, occurs in 20% to 50% of pregnancies complicated by chronic hypertension. The American College of Obstetricians and Gynecologists (ACOG) has released an updated practice bulletin to outline diagnosis, effects on pregnancy outcomes, and approaches for management based on new evidence.


When assessing patients diagnosed with hypertension before pregnancy or when they present for pregnancy care, a complete blood count and measurements of transaminase, creatinine, electrolyte, and blood urea nitrogen levels should be obtained as well as a spot urine protein/creatinine ratio, with a 24-hour urine test for total protein if elevated. Electrocardiography or echocardiography may be helpful in patients with signs of decreased cardiac function. Some tests

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of Practice Guidelines published in AFP is available at



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