guidelines

hypertension in pregnancy (gestational htn & pre-eclampsia)

nice-based diagnosis and management of hypertension in pregnancy: thresholds, targets, aspirin prophylaxis, medication choices, proteinuria testing, and escalation.

last reviewed: 2026-02-13
based on: NICE NG133 (published 25 Jun 2019; last updated 17 Apr 2023)
reviewer: Dr Kola Tytler MBBS CertHE MBA MRCGP
view official NICE source

Definitions and first steps

  • Hypertension in pregnancy: BP ≥140/90 mmHg (confirm with repeat measurement and correct technique).
  • Assess for pre-eclampsia features: headache, visual symptoms, RUQ/epigastric pain, vomiting, sudden oedema, reduced fetal movements; check urine for protein and arrange bloods (FBC, U&Es/creatinine, LFTs) as per pathway.
  • Proteinuria testing: use ACR or PCR rather than dip alone when PE suspected; follow local thresholds and repeat strategy.

Pre-eclampsia prevention and treatment targets (NICE)

  • Aspirin prophylaxis: offer 75–150 mg aspirin daily from 12 weeks until birth for those at high risk of pre-eclampsia (and consider for those with multiple moderate risk factors).
  • Treatment thresholds/targets: for women on antihypertensive therapy, aim for a target BP of 135/85 mmHg (individualise if symptoms of hypotension or fetal concerns).
  • Severe hypertension (e.g., ≥160/110) is an urgent scenario: same-day obstetric assessment and acute management pathway.

Antihypertensive choices (pragmatic)

Common first-line options in pregnancy (use local obstetric pathway and contraindications):

  • Labetalol (often first choice if no asthma/bradycardia/heart block).
  • Nifedipine MR (alternative where labetalol not suitable).
  • Methyldopa (alternative in selected patients; consider postpartum switch due to mood/sedation effects).

Avoid ACE inhibitors, ARBs, and (generally) thiazides during pregnancy unless specialist-directed.

Safety netting and escalation

  • Urgent escalation: severe-range BP, symptoms suggestive of PE, abnormal bloods, reduced fetal movements, or significant proteinuria.
  • Monitoring: BP trend, symptoms, urine protein, and bloods as per risk. Ensure clear follow-up plan and obstetric contact details.
  • Postpartum: review antihypertensives (many women de-escalate); ensure BP follow-up and cardiovascular risk counselling.

Frequently asked questions

What is the practical BP target once treated?
NICE recommends aiming for 135/85 mmHg in women receiving antihypertensive treatment during pregnancy, with individualisation where needed.
Who should get aspirin prophylaxis?
High-risk women (and some with multiple moderate risk factors) should be offered 75–150 mg daily from 12 weeks until birth; align with your local antenatal risk tool.
What should trigger same-day obstetric review?
Severe hypertension, new neurological or visual symptoms, epigastric/RUQ pain, abnormal bloods, significant proteinuria, or reduced fetal movements.

Transparency

This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.