How should I manage a pregnant patient with a history of hypertension and current elevated blood pressure readings?

For a pregnant patient with a history of chronic hypertension and current elevated blood pressure readings, management should include the following steps:

• Continue or initiate antihypertensive treatment if blood pressure is sustained at or above 140/90 mmHg, aiming for a target blood pressure of 135/85 mmHg or less during pregnancy.
• Preferred antihypertensive medications are labetalol as first-line; nifedipine if labetalol is unsuitable; and methyldopa if both labetalol and nifedipine are unsuitable. The choice should consider pre-existing treatment, side-effect profiles, fetal risks, and the woman's preferences.
• Stop any ACE inhibitors or angiotensin II receptor blockers immediately if the patient is taking these, as they are contraindicated in pregnancy, and switch to safer alternatives.
• Offer low-dose aspirin (75–150 mg daily) from 12 weeks gestation to reduce the risk of pre-eclampsia.
• Provide lifestyle advice on weight management, exercise, healthy eating, and salt reduction in line with hypertension guidelines.
• Monitor blood pressure regularly and assess for signs of pre-eclampsia, including proteinuria and maternal organ dysfunction.
• Arrange regular follow-up with maternity services and a review of antihypertensive treatment 6 to 8 weeks postpartum.

These steps align with NICE guidance on the diagnosis and management of hypertension in pregnancy.