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Cited by 598Pregnancy and preeclampsia studiesNeurological Complications and SyndromesBlood Pressure and Hypertension Studies

Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association

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Garovic, Vesna D., Dechend, Ralf, Easterling, Thomas, Karumanchi, S. Ananth, McMurtry Baird, Suzanne, Magee, Laura A., Rana, Sarosh, Vermunt, Jane V. +2 more·2022·Hypertension
DOI 10.1161/hyp.0000000000000208PMC PMC9031058
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Abstract

Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.

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  • Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and long-acting nifedipine, while hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia.

    “Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and longacting nifedipine, while hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia (151).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [151]

    The Antihypertensive medications section identifies labetalol and methyldopa as accepted first-line drugs and reports comparable safety and efficacy for hydralazine, labetalol, and nifedipine in acute severe hypertension. It also notes that not all societies recommend nifedipine as initial therapy and that fetal-safety data are limited, so the unqualified description of all three as known to be safe in pregnancy overstates the source. The copy provides no page numbers for these passages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Diuretics are not recommended for blood pressure management in pregnancy but may be used during late-stage pregnancy if needed for volume management.

    “Diuretics are not recommended for blood pressure management in pregnancy but may be used during latestage pregnancy if needed for volume management (151).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [151]

    The 'Antihypertensive medications' section (page unavailable) says diuretics are not used often in pregnant women, but it does not say they are categorically not recommended for blood-pressure management. It describes possible use in women with salt-sensitive chronic hypertension or chronic kidney disease and reduced GFR, not specifically during late-stage pregnancy for volume management. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and long-acting nifedipine, while hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia.

    “Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and longacting nifedipine, while hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia (56).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [56]

    The Antihypertensive medications section identifies labetalol and methyldopa as accepted first-line drugs and reports comparable safety and efficacy for hydralazine, labetalol, and nifedipine in acute severe hypertension during pregnancy. It does not establish the unqualified claim that all three listed drugs, specifically including long-acting nifedipine, are known to be safe throughout pregnancy: it notes limited and conflicting fetal-safety data and says not all societies support nifedipine as initial therapy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and long-acting nifedipine, while hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia.

    “Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and long-acting nifedipine, while hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia (72).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [72]

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Authors
Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., McMurtry Baird, S., Magee, L. A., Rana, S., Vermunt, J. V., August, P., & on behalf of the American Heart Association Council on Hypertension; Council on the Kidney in Cardiovascular Disease, K. I. H. D. S. C. C. O. A.
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-02
Volume
79
Issue
2
Pages
e21-e41
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/hyp.0000000000000208
PMC
PMC9031058
OpenAlex
W4200071622
Cited by
598
References
18
Citations by year
2026: 128 · 2025: 157 · 2024: 138 · 2023: 124 · 2022: 51
FWCI
71.44
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (R01HL136348)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
hypertensive disorders of pregnancy, preeclampsia, postpartum hypertension, cardiovascular disease risk in women, uteroplacental blood flow, proteinuria, maternal morbidity, miscarriage, racial and ethnic health disparities
MeSH terms
American Heart Association, Antihypertensive Agents, Blood Pressure, Female, Humans, Pregnancy, United States, Hypertension, Pregnancy-Induced

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