Intended for healthcare professionals

Clinical Review State of the Art Review

Hypertensive disorders of pregnancy

BMJ 2023; 381 doi: (Published 30 June 2023) Cite this as: BMJ 2023;381:e071653
  1. Pensée Wu, senior lecturer, honorary consultant obstetrician, adjunct associate professor123,
  2. Marcus Green, chief executive4,
  3. Jenny E Myers, professor, consultant obstetrician5
  1. 1School of Medicine, Keele University, Newcastle-under-Lyme, UK
  2. 2Academic Department of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, UK
  3. 3Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  4. 4Action on Pre-eclampsia, Evesham, UK
  5. 5Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
  1. Correspondence to: P Wu p.wu{at}


Hypertensive disorders of pregnancy (HDP) are one of the most commonly occurring complications of pregnancy and include chronic hypertension, gestational hypertension, and pre-eclampsia. New developments in early pregnancy screening to identify women at high risk for pre-eclampsia combined with targeted aspirin prophylaxis could greatly reduce the number of affected pregnancies. Furthermore, recent advances in the diagnosis of pre-eclampsia, such as placental growth factor based testing, have been shown to improve the identification of those pregnancies at highest risk of severe complications. Evidence from trials has refined the target blood pressure and timing of delivery to manage chronic hypertension and pre-eclampsia with non-severe features, respectively. Importantly, a wealth of epidemiological data now links HDP to future cardiovascular disease and diabetes decades after an affected pregnancy. This review discusses the current guidelines and research data on the prevention, diagnosis, management, and postnatal follow-up of HDP. It also discusses the gap in knowledge regarding the long term risks for cardiovascular disease following HDP and illustrates the importance of improving adherence to postnatal guidelines to monitor hypertension and the need for more research focused on primary prevention of future cardiovascular disease in women identified as being at high risk because of HDP.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: All authors planned the overall content of the article and edited and critically revised the whole article for intellectual content. PW and JEM did the literature review and wrote the initial draft of the article. PW is the guarantor.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: JEM has led research studies related to the implementation of angiogenic markers for the diagnosis of pre-eclampsia, received industry funding from Alere and Roche to fund biomarker research/implementation, and is a member of the NICE Diagnostic Assessment Panel; PW was a member of the NICE Guideline Committee for the hypertension in pregnancy guideline (2019 update).

  • Provenance and peer review: Commissioned; externally peer reviewed.

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