How should I approach the management of a pregnant patient with pre-existing hypertension who is planning to conceive?

Refer all women with a history of hypertension who wish to become pregnant to a specialist in hypertensive disorders prior to conception, as they will require careful monitoring and possible medication adjustments ¹.

Advise the woman that she will be at increased risk of pre-eclampsia during pregnancy and that she will need careful monitoring ¹.

Discuss the importance of continuing effective contraception until full assessment and management are completed ¹.

Ensure that her current antihypertensive medication is reviewed; avoid ACE inhibitors and ARBs due to increased risk of congenital abnormalities, and discuss alternative treatments with a specialist ¹.

Discuss pre-conception measures such as weight management, exercise, healthy eating, and salt reduction, in line with NICE guidelines ¹.