Hypertensive disorders in pregnancy (HDP), remain the leading cause of adverse maternal, fetal, and neonatal outcomes. Epidemiological factors, comorbidities, assisted reproduction techniques, placental disorders, and genetic predisposition determine the burden of the disease. The pathophysiological substrate and the clinical presentation of HDP are multifarious. The latter and the lack of well designed clinical trials in the field explain the absence of consensus on disease management among relevant international societies. Thus, the usual clinical management of HDP is largely empirical. The current position statement of the Working Group 'Hypertension in Women' of the European Society of Hypertension (ESH) aims to employ the current evidence for the management of HDP, discuss the recommendations made in the 2023 ESH guidelines for the management of hypertension, and shed light on controversial issues in the field to stimulate future research.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

3rd Department of Internal Medicine Papageorgiou Hospital Faculty of Medicine Aristotle University of Thessaloniki Greece

AP HP Hopital Avicenne Centre d'Excellence Europeen en Hypertension Arterielle Service de Medecine Interne INSERM UMR 942 MASCOT Paris 13 Universite Paris Nord Bobigny FCRIN INI CRCT

Cardiovascular Center and Clinical Pharmacology University Hospital Gent Belgium

Center for Cardiovascular Prevention Charles University Prague 1st Faculty of Medicine and Thomayer University Hospital

Charite Universitätsmedizin Berlin Institute of Clinical Pharmacology and Toxicology Berlin Germany

Department of Cardiology and Kolling Institute Royal North Shore Hospital St Leonards

Department of Cardiology General Hospital of Athens 'Laiko' Athens Greece

Department of Hypertension Hospital de Agudos J M Ramos Mejía Buenos Aires Argentina

Department of Hypertension University Medical Centre Ljubljana Medical University Ljubljana Slovenia

Department of Medicine 2 Charles University Prague 1st Faculty of Medicine Prague Czech Republic

Division of Cardiology Cliniques Universitaires Saint Luc and Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium

Faculty of Medicine and Health Sciences Macquarie University Sydney New South Wales Australia

Hypertension and Cardiovascular Risk Research Center Medical and Surgical Sciences Department Alma Mater Studiorum University of Bologna Bologna Italy

Medical Outpatient and Hypertension Clinic ESH Hypertension Centre of Excellence University Hospital Basel Basel Switzerland

School of Medicine University of Crete Heraklion Greece

University of Geneva Switzerland

Zobrazit více v PubMed

Thomopoulos C, Brguljan J, Cifkova R, Persu A, Kreutz R. Mild chronic hypertension in pregnancy: to treat or wait? Blood Press 2022; 31:121–124.

Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ. Maternal preeclampsia and neonatal outcomes. J Pregnancy 2011; 2011:214365.

Duffy J, Cairns AE, Richards-Doran D, van ’t Hooft J, Gale C, Brown M, et al. International Collaboration to Harmonise Outcomes for Preeclampsia (iHOPE). A core outcome set for preeclampsia research: an international consensus development study. BJOG 2020; 127:1516–1526.

Scott G, Gillon TE, Pels A, von Dadelszen P, Magee LA. Guidelines-similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension. Am J Obstet Gynecol 2022; 226:S1222–S1236.

Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41:1874–2071.

Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13:291–310.

Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, et al. ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165–3241.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953–2041.

Seely EW, Ecker J. Chronic hypertension in pregnancy. Circulation 2014; 129:1254–1261.

Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2022; 27:148–169.

Johnson S, Liu B, Kalafat E, Thilaganathan B, Khalil A. Maternal and perinatal outcomes of white coat hypertension during pregnancy: a systematic review and meta-analysis. Hypertension 2020; v76:157–166.

Bellomo G, Narducci PL, Rondoni F, Pastorelli G, Stangoni G, Angeli G, et al. Prognostic value of 24-h blood pressure in pregnancy. JAMA 1999; 282:1447–1452.

Lee-Ann Hawkins T, Brown MA, Mangos GJ, Davis GK. Transient gestational hypertension: not always a benign event. Pregnancy Hypertens 2012; 2:22–27.

Espeche WG, Salazar MR, Minetto J, Leiva Sisnieguez CE, Cerri G, Balbín E, et al. Hypertension arising after 20 weeks of gestation: gestational hypertension or masked chronic hypertension? J Hum Hypertens 2023; 37:813–817.

Nuckols VR, Stroud AK, Armstrong MK, Brandt DS, Santillan MK, Santillan DA, et al. Postpartum ambulatory and home blood pressure monitoring in women with history of preeclampsia: diagnostic agreement and detection of masked hypertension. Pregnancy Hypertens 2022; 29:23–29.

Salazar MR, Espeche WG, Leiva Sisnieguez CE, Juliano PL, Vulcano MV, Sanchez Caro L, et al. Masked hypertension and neonatal outcome in high-risk pregnancies. J Hum Hypertens 2023; 37:36–41.

Botero JP, McIntosh JJ. Labor and delivery: DIC, HELLP, preeclampsia. Hematology Am Soc Hematol Educ Program 2023; 2023:737–744.

GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1775–1812.

GBD 2015 Child Mortality Collaborators. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1725–1774.

Magee LA, Nicolaides KH, von Dadelszen P. Preeclampsia. N Engl J Med 2022; 386:1817–1832.

Kim MK, Lee SM, Bae SH, Kim HJ, Lim NG, Yoon SJ, et al. Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. Int J Equity Health 2018; 17:2.

Ross KM, Dunkel Schetter C, McLemore MR, Chambers BD, Paynter RA, Baer R, et al. Socioeconomic status, preeclampsia risk and gestational length in black and white women. J Racial Ethn Health Disparities 2019; 6:1182–1191.

Ling HZ, Jara PG, Bisquera A, Poon LC, Nicolaides KH, Kametas NA. Maternal cardiac function in women at high risk for preeclampsia treated with 150 mg aspirin or placebo: an observational study. BJOG 2020; 127:1018–1025.

Li LN, Li XD, Du J. The effect of aspirin on uterine arterial blood flow and endometrium in moderate and severe intrauterine adhesion after transcervical resection of adhesion: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2209818.

Osman MW, Nath M, Breslin E, Khalil A, Webb DR, Robinson TG, Mousa HA. Association between arterial stiffness and wave reflection with subsequent development of placental-mediated diseases during pregnancy: findings of a systematic review and meta-analysis. J Hypertens 2018; 36:1005–1014.

Thomopoulos C, Makris T. Gussak IB, Kostis JB. Iatrogenic aspects of hypertension in pregnancy. Iatrogenicity: causes and consequences of iatrogenesis in cardiovascular medicine . New Brunswick: Rutgers University Press; 2018. 143–155.

Cipolla MJ. Cerebrovascular function in pregnancy and eclampsia. Hypertension 2007; 50:14–24.

Ros HS, Lichtenstein P, Bellocco R, Petersson G, Cnattingius S. Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified? Am J Obstet Gynecol 2002; 186:198–203.

Sciscione AC, Ivester T, Largoza M, Manley J, Shlossman P, Colmorgen GH. Acute pulmonary edema in pregnancy. Obstet Gynecol 2003; 101:511–515.

Bello N, Rendon ISH, Arany Z. The relationship between preeclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol 2013; 62:1715–1723.

Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in pregnancy - pathophysiology, clinical characteristics, diagnostic scores, and treatments. J Blood Med 2022; 13:21–44.

Lindheimer MD, Taler SJ. Cunningham FG; American Society of Hypertension. ASH position paper: hypertension in pregnancy. J Clin Hypertens 2009; 11:214–225.

Hurrell A, Webster L, Chappell LC, Shennan AH. The assessment of blood pressure in pregnant women: pitfalls and novel approaches. Am J Obstet Gynecol 2022; 226:S804–S818.

Ashworth DC, Maule SP, Stewart F, Nathan HL, Shennan AH, Chappell LC. Setting and techniques for monitoring blood pressure during pregnancy. Cochrane Database Syst Rev 2020; 8:CD012739.

Turner MJ, Baker AB, Kam PC. Effects of systematic errors in blood pressure measurements on the diagnosis of hypertension. Blood Press Monit 2004; 9:249–253.

Stergiou GS, O’Brien E, Myers M, Palatini P, Parati G. STRIDE BP Scientific Advisory Board. STRIDE BP: an international initiative for accurate blood pressure measurement. J Hypertens 2020; 38:395–399.

Kho CL, Brown MA, Ong SL, Mangos GJ. Blood pressure measurement in pregnancy: the effect of arm circumference and sphygmomanometer cuff size. Obstet Med 2009; 2:116–120.

de Haas S, Mulder E, Schartmann N, Mohseni Z, Abo Hasson F, Alsadah F, et al. Blood pressure adjustments throughout healthy and hypertensive pregnancy: a systematic review and meta-analysis. Pregnancy Hypertens 2022; 27:51–58.

Hauspurg A, Parry S, Mercer BM, Grobman W, Hatfield T, Silver RM, et al. Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women. Am J Obstet Gynecol 2019; 221:e1–e8.

Porcelli BA, Diveley E, Meyenburg K, Woolfolk C, Rosenbloom JI, Raghuraman N, et al. A new definition of gestational hypertension? New-onset blood pressures of 130 to 139/80 to 89 mm Hg after 20 weeks of gestation. Am J Obstet Gynecol 2020; 223:e1–e7.

Mikami Y, Takai Y, Era S, Ono Y, Saitoh M, Baba K, et al. Provisional criteria for the diagnosis of hypertension in pregnancy using home blood pressure measurements. Hypertens Res 2017; 40:679–684.

Brown MA. Is there a role for ambulatory blood pressure monitoring in pregnancy? Clin Exp Pharmacol Physiol 2014; 41:16–21.

Dougall G, Franssen M, Tucker KL, Yu LM, Hinton L, Rivero-Arias O, et al. Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials. BMJ Open 2020; 10:e034593.

Tucker KL, Mort S, Yu LM, Campbell H, Rivero-Arias O, Wilson HM, et al. BUMP Investigators. Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 Randomized Clinical Trial. JAMA 2022; 327:1656–1665.

Chappell LC, Tucker KL, Galal U, Yu LM, Campbell H, Rivero-Arias O, et al. BUMP 2 Investigators. Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 Randomized Clinical Trial. JAMA 2022; 327:1666–1678.

Pealing LM, Tucker KL, Mackillop LH, Crawford C, Wilson H, Nickless A, et al. OPTIMUM-BP Investigators. A randomised controlled trial of blood pressure self-monitoring in the management of hypertensive pregnancy. OPTIMUM-BP: a feasibility trial. Pregnancy Hypertens 2019; 18:141–149.

Brown MA, Davis GK, McHugh L. The prevalence and clinical significance of nocturnal hypertension in pregnancy. J Hypertens 2001; 19:1437–1444.

Brown MA, Mangos G, Davis G, Homer C. The natural history of white coat hypertension during pregnancy. BJOG 2005; 112:601–606.

O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, Carbone IF, et al. Multicenter screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017; 49:756–760.

Brown MA, Robinson A, Bowyer L, Buddle ML, Martin A, Hargood JL, et al. Ambulatory blood pressure monitoring in pregnancy: what is normal? Am J Obstet Gynecol 1998; 178:836–842.

Schmella MJ, Clifton RG, Althouse AD, Roberts JM. Uric acid determination in gestational hypertension: is it as effective a delineator of risk as proteinuria in high-risk women? Reprod Sci 2015; 22:1212–1219.

Chappell LC, Shennan AH. Assessment of proteinuria in pregnancy. BMJ 2008; 336:968–969.

Waugh J, Hooper R, Lamb E, Robson S, Shennan A, Milne F, et al. Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of preeclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis. Health Technol Assess 2017; 21:1–90.

Bartsch E, Medcalf KE, Park AL. Ray JG; High Risk of Preeclampsia Identification Group. Clinical risk factors for preeclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016; 353:i1753.

Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, et al. American Heart Association Council on Hypertension; Council on the Kidney in Cardiovascular Disease, Kidney in Heart Disease Science Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association. Hypertension 2022; 79:e21–e41.

Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: pathophysiology, challenges, and perspectives. Circ Res 2019; 124:1094–1112.

Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377:613–622.

Duhig KE, Myers J, Seed PT, Sparkes J, Lowe J, Hunter RM, et al. PARROT Trial Group. Placental growth factor testing to assess women with suspected preeclampsia: a multicentre, pragmatic, steppedwedge cluster-randomised controlled trial. Lancet 2019; 393:1807–1818.

Wright D, Wright A, Nicolaides KH. The competing risk approach for prediction of preeclampsia. Am J Obstet Gynecol 2020; 223:12.e7–23.e7.

Hurrell A, Webster L, Sparkes J, Battersby C, Brockbank A, Clark K, et al. PARROT-2 trial group. Repeat placental growth factor-based testing in women with suspected preterm preeclampsia (PARROT-2): a multicentre, parallel-group, superiority, randomised controlled trial. Lancet 2024; 403:619–631.

Döbert M, Wright A, Varouxaki AN, Mu AC, Syngelaki A, Rehal A, et al. STATIN trial: predictive performance of competing-risks model in screening for preeclampsia at 35-37 weeks’ gestation. Ultrasound Obstet Gynecol 2022; 59:69–75.

von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton Pipkin F, et al. Prediction of adverse maternal outcomes in preeclampsia: development and validation of the fullPIERS model. Lancet 2011; 377:219–227.

Ukah UV, Payne B, Karjalainen H, Kortelainen E, Seed PT, Conti-Ramsden FI, et al. Temporal and external validation of the fullPIERS model for the prediction of adverse maternal outcomes in women with preeclampsia. Pregnancy Hypertens 2019; 15:42–50.

Ukah UV, Payne B, Hutcheon JA, Ansermino JM, Ganzevoort W, Thangaratinam S, et al. Assessment of the fullPIERS Risk Prediction Model in Women With Early-Onset Preeclampsia. Hypertension 2018; 71:659–665.

Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216:110.e6–120.e6.

Bujold E, Roberge S, Nicolaides KH. Low-dose aspirin for prevention of adverse outcomes related to abnormal placentation. Prenat Diagn 2014; 34:642–648.

Caron N, Rivard GÉ, Michon N, Morin F, Pilon D, Moutquin JM, Rey E. Low-dose ASA response using the PFA-100 in women with high-risk pregnancy. J Obstet Gynaecol Can 2009; 31:1022–1027.

Richards EMF, Giorgione V, Stevens O, Thilaganathan B. Low-dose aspirin for the prevention of superimposed preeclampsia in women with chronic hypertension: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 228:395–408.

Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2018; 10:CD001059.

Sammour MB, El-Kabarity H, Fawzy MM, Schindler AE. Prevention and treatment of preeclampsia and eclampsia. J Steroid Biochem Mol Biol 2005; 97:439–440.

Woo Kinshella ML, Sarr C, Sandhu A, Bone JN, Vidler M, Moore SE, et al. Calcium for preeclampsia prevention: a systematic review and network meta-analysis to guide personalised antenatal care. BJOG 2022; 129:1833–1843.

Institute of Medicine (US) Committee to review dietary reference intakes for vitamin D and calcium. In Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary reference intakes for calcium and vitamin D. Washington (DC): National Academies Press (US); 2011.

Kasawara KT, Nascimento SLDo, Costa ML, Surita FG, E Silva JLP. Exercise and physical activity in the prevention of preeclampsia: systematic review. Acta Obstet Gynecol Scand 2012; 91:1147–1157.

Magro-Malosso ER, Saccone G, Di Tommaso M, Roman A, Berghella V. Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2017; 96:921–931.

Martínez-Vizcaíno V, Sanabria-Martínez G, Fernández-Rodríguez R, Cavero-Redondo I, Pascual-Morena C, Álvarez-Bueno C, Martínez-Hortelano JA. Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta-analysis. BJOG An Int J Obstet Gynaecol 2023; 130:264–275.

Xing Y, Wang X, Zhang W, Jiang H. The effect of exercise on maternal complications and birth outcomes in overweight or obese pregnant women: a meta-analysis. Ann Palliat Med 2020; 9:4103–4112.

Muhammad HFL, Pramono A, Rahman MN. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: a systematic review and meta-analysis of randomized controlled trials. Clin Obes 2021; 11:e12428.

Xie E, Tao H, Liu M, Li C, Zhao Q. The effect of exercise on the prevention of gestational hypertension in obese and overweight pregnant women: an updated meta-analysis. Front Public Health 2022; 10:923161.

Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion, Number 804. Obstet Gynecol 2020; 135:e178–e188.

Ruifrok AE, Van Poppel MNM, Van Wely M, Rogozińska E, Khan KS, De Groot CJM, et al. Association between weight gain during pregnancy and pregnancy outcomes after dietary and lifestyle interventions: a meta-analysis. Am J Perinatol 2014; 31:353–364.

Ren M, Li H, Cai W, Niu X, Ji W, Zhang Z, et al. Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis. BMC Pregnancy Childbirth 2018; 18:281.

Santos S, Voerman E, Amiano P, Barros H, Beilin LJ, Bergström A, et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG 2019; 126:984–995.

Yilmaz ZV, Akkaş E, Türkmen GG, Kara Ö, Yücel A, Uygur D. Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia. Hypertens Pregnancy 2017; 36:77–83.

Birukov A, Andersen LB, Herse F, Rakova N, Kitlen G, Kyhl HB, et al. Preeclampsia ALDOSTERONE, SALT, AND POTASSIUM INTAKES AS PREDICTORS OF PREGNANCY OUTCOME, INCLUDING PREECLAmpsia. Hypertension 2019; 74:391–398.

Arvizu M, Bjerregaard AA, Madsen MTB, Granström C, Halldorsson TI, Olsen SF, et al. Sodium intake during pregnancy, but not other diet recommendations aimed at preventing cardiovascular disease, is positively related to risk of hypertensive disorders of pregnancy. J Nutr 2020; 150:159–166.

Knuist M, Bonsel GJ, Zondervan HA, Treffers PE. Low sodium diet and pregnancy-induced hypertension: a multicentre randomised controlled trial. Br J Obs Gynaecol 1998; 105:430–434.

Duley L, Henderson-Smart DJ. Reduced salt intake compared to normal dietary salt, or high intake, in pregnancy. Cochrane Database Syst Rev 2000; 1999:CD001687.

Webster K, Fishburn S, Maresh M, Findlay SC, Chappell LC, Guideline C. Guideline Committee. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. BMJ 2019; 366:l5119.

Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379:513–523.

Döbert M, Varouxaki AN, Mu AC, Syngelaki A, Ciobanu A, Akolekar R, et al. Pravastatin versus placebo in pregnancies at high risk of term preeclampsia. Circulation 2021; 144:670–679.

Magun E, DeFilippis EM, Noble S, LaSala A, Waksmonski C, D’Alton ME, Haythe J. Cardiovascular care for pregnant women with cardiovascular disease. J Am Coll Cardiol 2020; 76:2102–2113.

Piani F, Degli Esposti D, Agnoletti D, Borghi C. Bologna HDP Study Group. Does a multidisciplinary team involving internists specialized in hypertension and obstetric medicine improve pregnancy outcomes? Eur J Intern Med 2023; 117:148–150.

Moretti ME, Caprara D, Drehuta I, Yeung E, Cheung S, Federico L, Koren G. The fetal safety of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Obstet Gynecol Int 2012; 2012:658310.

Hoeltzenbein M, Tissen-Diabaté T, Fietz AK, Zinke S, Kayser A, Meister R, et al. Pregnancy outcome after first trimester use of angiotensin AT1 receptor blockers: an observational cohort study. Clin Res Cardiol 2018; 107:679–687.

Hoeltzenbein M, Tissen-Diabaté T, Fietz AK, Zinke S, Kayser A, Meister R, et al. Increased rate of birth defects after first trimester use of angiotensin converting enzyme inhibitors - Treatment or hypertension related? An observational cohort study. Pregnancy Hypertens 2018; 13:65–71.

Weber-Schoendorfer C, Kayser A, Tissen-Diabaté T, Winterfeld U, Eleftheriou G, Te Winkel B, et al. Fetotoxic risk of AT1 blockers exceeds that of angiotensin-converting enzyme inhibitors: an observational study. J Hypertens 2020; 38:133–141.

Hoeltzenbein M, Beck E, Fietz AK, Wernicke J, Zinke S, Kayser A, et al. Pregnancy outcome after first trimester use of methyldopa: a prospective cohort study. Hypertension 2017; 70:201–208.

Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med 2015; 372:407–417.

Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2018; 10:CD002252.

Tita AT, Szychowski JM, Boggess K, Dugoff L, Sibai B, Lawrence K, et al. Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022; 386:1781–1792.

Whelan A, Izewski J, Berkelhammer C, Walloch J, Kay HH. Labetalol-induced hepatotoxicity during pregnancy: a case report. AJP Rep 2020; 10:e210–e212.

Butters L, Kennedy S, Rubin PC. Atenolol in essential hypertension during pregnancy. BMJ 1990; 301:587–589.

Hoeltzenbein M, Fietz AK, Kayser A, Zinke S, Meister R, Weber-Schoendorfer C, Schaefer C. Pregnancy outcome after first trimester exposure to bisoprolol: an observational cohort study. J Hypertens 2018; 36:2109–2117.

Kayser A, Beck E, Hoeltzenbein M, Zinke S, Meister R, Weber-Schoendorfer C, et al. Neonatal effects of intrauterine metoprolol/bisoprolol exposure during the second and third trimester: a cohort study with two comparison groups. J Hypertens 2020; 38:354–361.

WHO Expert Committee on Arterial Hypertension & World Health Organization. Arterial hypertension: report of a WHO expert committee [meeting held in Geneva from 13 to 21 March 1978]. Geneva: World Health Organization; 1978.

Guidelines for the treatment of mild hypertension. Memorandum from a WHO/ISH meeting. Hypertension 1983; 5:394–397.

WHO. 1986 guidelines for the treatment of mild hypertension: memorandum from a WHO/ISH meeting. J Hypertens 1986; 4:383–386.

Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17:151–183.

Meinert F, Thomopoulos C, Kreutz R. Sex and gender in hypertension guidelines. J Hum Hypertens 2023; 37:654–661.

McLaughlin K, Scholten RR, Kingdom JC, Floras JS, Parker JD. Should maternal hemodynamics guide antihypertensive therapy in preeclampsia? Hypertension 2018; 71:550–556.

Vasapollo B, Zullino S, Novelli GP, Farsetti D, Ottanelli S, Clemenza S, et al. Maternal hemodynamics from preconception to delivery: research and potential diagnostic and therapeutic implications: position statement by Italian Association of Pre-Eclampsia and Italian Society of Perinatal Medicine. Am J Perinatol 2024; doi: 10.1055/a-2267-3994. DOI

Stott D, Papastefanou I, Paraschiv D, Clark K, Kametas NA. Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension. Ultrasound Obstet Gynecol 2017; 49:95–103.

Mulder EG, Ghossein-Doha C, Cauffman E, Lopes van Balen VA, Schiffer VMMM, Alers RJ, et al. Preventing recurrent preeclampsia by tailored treatment of nonphysiologic hemodynamic adjustments to pregnancy. Hypertension 2021; 77:2045–2053.

Gupta M, Greene N, Kilpatrick SJ. Timely treatment of severe maternal hypertension and reduction in severe maternal morbidity. Pregnancy Hypertens 2018; 14:55–58.

Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 2003; 327:955–960.

Antza C, Dimou C, Doundoulakis I, Akrivos E, Stabouli S, Haidich AB, et al. The flipside of hydralazine in pregnancy: a systematic review and meta-analysis. Pregnancy Hypertens 2020; 19:177–186.

Sridharan K, Sequeira RP. Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol 2018; 84:1906–1916.

Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, et al. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother 2020; 6:384–393.

Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med 2016; 374:13–22.

Verlohren S, Brennecke SP, Galindo A, Karumanchi SA, Mirkovic LB, Schlembach D, et al. Clinical interpretation and implementation of the sFlt-1/PlGF ratio in the prediction, diagnosis and management of preeclampsia. Pregnancy Hypertens 2022; 27:42–50.

El Farra J, Bean C, Martin JN Jr. Management of hypertensive crisis for the obstetrician/gynecologist. Obstet Gynecol Clin North Am 2016; 43:623–637.

Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with preeclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359:1877–1890.

Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with preeclampsia. Cochrane Database Syst Rev 2010; 2010:CD000025.

Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Early standardized treatment of critical blood pressure elevations is associated with a reduction in eclampsia and severe maternal morbidity. Am J Obstet Gynecol 2017; 216:415.e1–415.e5.

Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 2019; 24:164–189.

Pappaccogli M, Prejbisz A, Ciurică S, Bruno RM, Aniszczuk-Hybiak A, Bracalente I, et al. European/International Fibromuscular Dysplasia Registry and Initiative (FEIRI) and the Working Group “Hypertension and the Kidney” of the ESH. Pregnancy-related complications in patients with fibromuscular dysplasia: a report from the European/International Fibromuscular Dysplasia Registry. Hypertension 2020; 76:545–553.

Lenders JW. Pheochromocytoma and pregnancy: a deceptive connection. Eur J Endocrinol 2012; 166:143–150.

Langton K, Tufton N, Akker S, Deinum J, Eisenhofer G, Timmers H, et al. Pregnancy and phaeochromocytoma/paraganglioma: clinical clues affecting diagnosis and outcome - a systematic review. BJOG 2021; 128:1264–1272.

Lenders JWM, Langton K, Langenhuijsen JF, Eisenhofer G. Pheochromocytoma and pregnancy. Endocrinol Metab Clin North Am 2019; 48:605–617.

Bancos I, Atkinson E, Eng C, Young WF Jr, Neumann HPH. International Pheochromocytoma and Pregnancy Study Group. Maternal and fetal outcomes in phaeochromocytoma and pregnancy: a multicentre retrospective cohort study and systematic review of literature. Lancet Diabetes Endocrinol 2021; 9:13–21.

Cabiddu G, Mannucci C, Fois A, Maxia S, Chatrenet A, Osadolor S, et al. Preeclampsia is a valuable opportunity to diagnose chronic kidney disease: a multicentre study. Nephrol Dial Transplant 2022; 37:1488–1498.

Filali Khattabi Z, Biolcati M, Fois A, Chatrenet A, Laroche D, Attini R, et al. Chronic kidney disease in preeclamptic patients: not found unless searched for-Is a nephrology evaluation useful after an episode of preeclampsia? J Nephrol 2019; 32:977–987.

Rolfo A, Attini R, Tavassoli E, Neve FV, Nigra M, Cicilano M, et al. Is it possible to differentiate chronic kidney disease and preeclampsia by means of new and old biomarkers? A prospective study. Dis Markers 2015; 2015:127083.

Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, Ravani P. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis 2007; 49:753–762.

Bramham K, Seed PT, Lightstone L, Nelson-Piercy C, Gill C, Webster P, et al. Diagnostic and predictive biomarkers for preeclampsia in patients with established hypertension and chronic kidney disease. Kidney Int 2016; 89:874–885.

Perni U, Sison C, Sharma V, Helseth G, Hawfield A, Suthanthiran M, August P. Angiogenic factors in superimposed preeclampsia: a longitudinal study of women with chronic hypertension during pregnancy. Hypertension 2012; 59:740–746.

Kwiatkowski S, Bednarek-Jędrzejek M, Kwiatkowska E, Cymbaluk-Płoska A, Torbè A. Diagnosis of placental insufficiency independently of clinical presentations using sFlt-1/PLGF ratio, including SGA patients. Pregnancy Hypertens 2021; 25:244–248.

Landau E, Amar L. Primary aldosteronism and pregnancy. Ann Endocrinol (Paris) 2016; 77:148–160.

Downie E, Shanmugalingam R, Hennessy A, Makris A. Assessment and management of primary aldosteronism in pregnancy: a case-control study. J Clin Endocrinol Metab 2022; 107:e3152–e3158.

Liszewski W, Boull C. Lack of evidence for feminization of males exposed to spironolactone in utero: a systematic review. J Am Acad Dermatol 2019; 80:1147–1148.

Walters BN, Thompson ME, Lee A, de Swiet M. Blood pressure in the puerperium. Clin Sci (Lond) 1986; 71:589–594.

Lopes Perdigao J, Lewey J, Hirshberg A, Koelper N, Srinivas SK, Elovitz MA, Levine LD. Furosemide for accelerated recovery of blood pressure postpartum in women with a hypertensive disorder of pregnancy: a randomized controlled trial. Hypertension 2021; 77:1517–1524.

Walters BN, Walters T. Hypertension in the puerperium. Lancet 1987; 2:330.

Geller DS, Farhi A, Pinkerton N, Fradley M, Moritz M, Spitzer A, et al. Activating mineralocorticoid receptor mutation in hypertension exacerbated by pregnancy. Science 2000; 289:119–123.

Kitt J, Fox R, Frost A, Shanyinde M, Tucker K, Bateman PA, et al. Long-term blood pressure control after hypertensive pregnancy following physician-optimized self-management: the POP-HT Randomized Clinical Trial. JAMA 2023; 330:1991–1999.

Kitt J, Krasner S, Barr L, Frost A, Tucker K, Bateman PA, et al. Cardiac remodeling after hypertensive pregnancy following physician-optimized blood pressure self-management: the POP-HT Randomized Clinical Trial Imaging Substudy. Circulation 2024; 149:529–541.

Wiciński M, Malinowski B, Puk O, Socha M, Słupski M. Methyldopa as an inductor of postpartum depression and maternal blues: a review. Biomed Pharmacother 2020; 127:110196.

Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension 2008; 51:960–969.

Breitzka RL, Sandritter TL, Hatzopoulos FK. Principles of drug transfer into breast milk and drug disposition in the nursing infant. J Hum Lact 1997; 13:155–158.

Seeho SK, Algert CS, Roberts CL, Ford JB. Early-onset preeclampsia appears to discourage subsequent pregnancy but the risks may be overestimated. Am J Obstet Gynecol 2016; 215:785.e1–785.e8.

Giannubilo SR, Landi B, Ciavattini A. Preeclampsia: what could happen in a subsequent pregnancy? Obstet Gynecol Surv 2014; 69:747–762.

van Oostwaard MF, Langenveld J, Schuit E, Papatsonis DN, Brown MA, Byaruhanga RN, et al. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol 2015; 212:624.e1–624.e17.

Ebbing C, Rasmussen S, Skjaerven R, Irgens LM. Risk factors for recurrence of hypertensive disorders of pregnancy, a population-based cohort study. Acta Obstet Gynecol Scand 2017; 96:243–250.

Cnattingius S, Wikström AK, Stephansson O, Johansson K. The impact of small for gestational age births in early and late preeclamptic pregnancies for preeclampsia recurrence: a cohort study of successive pregnancies in Sweden. Paediatr Perinat Epidemiol 2016; 30:563–570.

Ohamadike O, Lim SL, Siegel A, Zemtsov G, Kuller JA, Dotters-Katz S. Hypertensive disorders of pregnancy: common clinical conundrums. Obstet Gynecol Surv 2022; 77:234–244.

Chih HJ, Elias FTS, Gaudet L, Velez MP. Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses. BMC Pregnancy Childbirth 2021; 21:449.

Thomopoulos C, Salamalekis G, Kintis K, Andrianopoulou I, Michalopoulou H, Skalis G, et al. Risk of hypertensive disorders in pregnancy following assisted reproductive technology: overview and meta-analysis. J Clin Hypertens (Greenwich) 2017; 19:173–183.

Pohjonen EM, Söderström-Anttila V, Bergh C, Loft A, Magnusson Å, Pinborg A, et al. Obstetric and perinatal risks after the use of donor sperm: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 274:210–228.

Kyrou D, Kolibianakis EM, Devroey P, Fatemi HM. Is the use of donor sperm associated with a higher incidence of preeclampsia in women who achieve pregnancy after intrauterine insemination? Fertil Steril 2010; 93:1124–1127.

Blázquez A, García D, Rodríguez A, Vassena R, Figueras F, Vernaeve V. Is oocyte donation a risk factor for preeclampsia? A systematic review and meta-analysis. J Assist Reprod Genet 2016; 33:855–863.

Busnelli A, Schirripa I, Fedele F, Bulfoni A, Levi-Setti PE. Obstetric and perinatal outcomes following programmed compared to natural frozen-thawed embryo transfer cycles: a systematic review and meta-analysis. Hum Reprod 2022; 37:1619–1641.

Manna C, Lacconi V, Rizzo G, De Lorenzo A, Massimiani M. Placental dysfunction in assisted reproductive pregnancies: perinatal, neonatal and adult life outcomes. Int J Mol Sci 2022; 23:659.

Pereira MM, Mainigi M, Strauss JF. Secretory products of the corpus luteum and preeclampsia. Hum Reprod Update 2021; 27:651–672.

Mills G, Badeghiesh A, Suarthana E, Baghlaf H, Dahan MH. Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Hum Reprod 2020; 35:1666–1674.

Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009; 53:944–951.

Männistö T, Mendola P, Vääräsmäki M, Järvelin MR, Hartikainen AL, Pouta A, Suvanto E. Elevated blood pressure in pregnancy and subsequent chronic disease risk. Circulation 2013; 127:681–690.

Honigberg MC, Zekavat SM, Aragam K, Klarin D, Bhatt DL, Scott NS, et al. Long-term cardiovascular risk in women with hypertension during pregnancy. J Am Coll Cardiol 2019; 74:2743–2754.

Inversetti A, Pivato CA, Cristodoro M, Latini AC, Condorelli G, Di Simone N, et al. Update on long-term cardiovascular risk after preeclampsia: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2024; 10:4–13.

Khashan AS, Evans M, Kublickas M, McCarthy FP, Kenny LC, Stenvinkel P, et al. Preeclampsia and risk of end stage kidney disease: a Swedish nationwide cohort study. PLoS Med 2019; 16:e1002875.

Grandi SM, Filion KB, Yoon S, Ayele HT, Doyle CM, Hutcheon JA, et al. Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications. Circulation 2019; 139:1069–1079.

Rayes B, Ardissino M, Slob EAW, Patel KHK, Girling J, Ng FS. Association of hypertensive disorders of pregnancy with future cardiovascular disease. JAMA Netw Open 2023; 6:e230034.

Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, et al. Preeclampsia and future cardiovascular health: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2017; 10:e003497.

Roberts JM, Hubel CA. The two stage model of preeclampsia: variations on the theme. Placenta 2009; 30:S32–S37.

Staff AC, Dechend R, Pijnenborg R. Learning from the placenta: acute atherosis and vascular remodeling in preeclampsia-novel aspects for atherosclerosis and future cardiovascular health. Hypertension 2010; 56:1026–1034.

Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, et al. ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227–3337.

Parikh NI, Gonzalez JM, Anderson CAM, Judd SE, Rexrode KM, Hlatky MA, et al. American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association. Circulation 2021; 143:e902–e916.

Yang H, Kuhn C, Kolben T, Ma Z, Lin P, Mahner S, et al. Early life oxidative stress and long-lasting cardiovascular effects on offspring conceived by assisted reproductive technologies: a review. Int J Mol Sci 2020; 21:E5175.

MacDonald TM, Walker SP, Hannan NJ, Tong S, Kaitu’u-Lino TJ. Clinical tools and biomarkers to predict preeclampsia. EBioMedicine 2022; 75:103780.

Nguyen TPH, Patrick CJ, Parry LJ, Familari M. Using proteomics to advance the search for potential biomarkers for preeclampsia: a systematic review and meta-analysis. PLoS One 2019; 14:e0214671.

Smith DD, Costantine MM. The role of statins in the prevention of preeclampsia. Am J Obstet Gynecol 2022; 226:S1171–S1181.

Vahedian-Azimi A, Karimi L, Reiner Ž, Makvandi S, Sahebkar A. Effects of statins on preeclampsia: a systematic review. Pregnancy Hypertens 2021; 23:123–130.

Aldridge E, Pathirana M, Wittwer M, Sierp S, Roberts CT, Dekker GA, Arstall M. Women's awareness of cardiovascular disease risk after complications of pregnancy. Women Birth 2023; 36:e335–e340.

Wilson BJ, Watson MS, Prescott GJ, Sunderland S, Campbell DM, Hannaford P, Smith WC. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ 2003; 326:845.

Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM. Preeclampsia and the risk of end-stage renal disease. N Engl J Med 2008; 359:800–809.