What are the indications for initiating antihypertensive therapy in pregnant patients with gestational hypertension?

Antihypertensive therapy should be initiated in pregnant patients with gestational hypertension if their blood pressure remains above 140/90 mmHg. For all women with gestational hypertension, pharmacological treatment is recommended if blood pressure is persistently elevated above this threshold. In cases of severe hypertension, defined as blood pressure of 160/110 mmHg or greater, antihypertensive treatment should be offered to all women, and hospital admission is recommended for close monitoring. The target blood pressure once on antihypertensive treatment is 135/85 mmHg or less. The choice of antihypertensive agent should consider side-effect profiles, fetal risks, and the woman's preferences, with labetalol as the first-line treatment, nifedipine as an alternative, and methyldopa if the others are unsuitable.

Women with gestational hypertension should be assessed in secondary care by professionals trained in hypertensive disorders of pregnancy, and management includes regular blood pressure monitoring, proteinuria testing, and fetal surveillance. Admission is advised if blood pressure reaches or exceeds 160/110 mmHg. Planned early delivery before 37 weeks is generally not recommended unless blood pressure is severe or other medical indications exist.