Maternal & Newborn Atlas
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Hypertensive disorders of pregnancy

High blood pressure that is present before pregnancy or starts during it. NICE groups these disorders in three ways: high blood pressure that was there before pregnancy or appeared in the first 20 weeks (chronic hypertension), new high blood pressure that starts in the second half of pregnancy (called gestational hypertension), and new high blood pressure with signs that other organs are affected (pre-eclampsia). NICE puts the share of pregnant women affected at about 8% to 10%.

Also called Hypertension in pregnancy · HDP

  • Condition
  • In this atlas

Overview

Technical summary

Umbrella for chronic hypertension, gestational hypertension and pre-eclampsia, as the NICE guideline NG133 groups them in its Context chapter. NG133 treats a systolic pressure of 140 mmHg or more, or a diastolic pressure of 90 mmHg or more, as hypertension, and gestational hypertension as high blood pressure that starts after 20 weeks of pregnancy with no significant protein in the urine. This atlas has records for chronic hypertension in pregnancy and for pre-eclampsia; gestational hypertension has no record of its own yet. Some guidance applies to the whole group (NG133 recommendations 1.9 and 1.10, and WHO 2020 for non-severe hypertension), which is why this umbrella exists. NG133 notes that its update did not review treatment for the three types of hypertension in pregnancy as one group. The maternal context is the default here; effects on the fetus or newborn sit in claims with their own contexts. WHO’s 2020 guideline says they are behind about 14% of maternal deaths around the world.

Burden

No burden claims are published.

Claims and evidence

Context Women who have had a hypertensive disorder of pregnancy, later life (NICE NG133 recommendation 1.10.2)

Recipient
Maternal
Population
Women who have had any hypertensive disorder of pregnancy (chronic hypertension, gestational hypertension or pre-eclampsia), compared by NICE with women who did not have one. The risks NICE reports are overall estimates drawn from several studies.
Care setting
Advice at transfer to community care after a hypertensive disorder of pregnancy.
Geography
England. NICE's terms and conditions present the information on its websites as support for people in England who make decisions about funding care (clause 6) and say it is not written as a basis for decisions outside the United Kingdom (clause 8). The guideline page states no jurisdiction of its own.
Life stage
Postpartum and later life
Gestational age
Not reported
Postnatal age
Not reported
Follow-up
NICE gives no single follow-up time: it says follow-up in the underlying studies ranged from 1 to 40 years postpartum.
Eligibility: 1 inclusion criterion; 1 exclusion criterion
Included
  • Women who have had a hypertensive disorder of pregnancy
Excluded
  • Not stated in the recommendation

  • Description Guidance Certainty not assessed

    NICE (recommendation 1.10.2) tells clinicians to explain to women who had any type of hypertensive disorder during pregnancy that these disorders are linked with a raised chance of hypertension and cardiovascular disease as they get older. NICE’s Table 6 gives approximate sizes of the increase for each type of disorder.

    Applies to Maternal
    • Women who have had any hypertensive disorder of pregnancy (chronic hypertension, gestational hypertension or pre-eclampsia), compared by NICE with women who did not have one. The risks NICE reports are overall estimates drawn from several studies.
    • Advice at transfer to community care after a hypertensive disorder of pregnancy.
    • England. NICE's terms and conditions present the information on its websites as support for people in England who make decisions about funding care (clause 6) and say it is not written as a basis for decisions outside the United Kingdom (clause 8). The guideline page states no jurisdiction of its own.
    • Postpartum and later life
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up NICE gives no single follow-up time: it says follow-up in the underlying studies ranged from 1 to 40 years postpartum.
    Certainty method
    Not assessed
    Limitations
    This is guidance that summarises other studies, not a new analysis. It covers any hypertensive disorder of pregnancy, so it must not be read as pre-eclampsia alone carrying the risk; Table 6 has separate columns for pre-eclampsia, gestational hypertension and chronic hypertension, and some cells say the risk may be increased or give no data. NICE says the figures in the table are overall estimates that condense results reported as risk, odds or hazard ratios, and that the comparison group is women who did not have a hypertensive disorder in pregnancy. Table 6 marks the later-hypertension row as not applicable for chronic hypertension. The table gives no absolute risks, since they depend on the follow-up time. The page does not state a jurisdiction; England is inferred from the issuer.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports Hypertension in pregnancy: diagnosis and management (NICE guideline NG133), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The version shown on 2026-10-11, with a page header that gives 17 April 2023 as the last update. The same bytes came back on a second fetch minutes later. · Published 2019-06-25 · nice: NG133

      Locator
      Recommendation 1.10.2, fragments 1 and 2
      How it applies
      NICE guideline NG133; cited and linked only, with no NICE wording on public pages.
      Retrieved
      Source effective date
      2023-04-17
      Source state
      Current
      Snapshot hash
      0cd8548f5807f03a82b3101dc56ebadf674106da9d0aa7e57955d4a823556fca
      Reuse basis
      The page bytes are not committed. Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE reuse terms, read on 2026-10-11: the NICE UK Open Content Licence covers use in a UK setting only, international use outside personal research and study needs a licence and a fee, and the NICE terms and conditions make content available for artificial intelligence purposes only through an approval process, a licence and a fee for international use. This pipeline uses AI agents to read the page, so Ben decided on 2026-10-13 that public pages cite and link NICE and use none of its wording.

    2. Background Hypertension in pregnancy: diagnosis and management (NICE guideline NG133), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The version shown on 2026-10-11, with a page header that gives 17 April 2023 as the last update. The same bytes came back on a second fetch minutes later. · Published 2019-06-25 · nice: NG133

      Locator
      Table 6, column heading
      How it applies
      Chronic hypertension has its own column.
      Retrieved
      Source effective date
      2023-04-17
      Source state
      Current
      Snapshot hash
      0cd8548f5807f03a82b3101dc56ebadf674106da9d0aa7e57955d4a823556fca
      Reuse basis
      The page bytes are not committed. Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE reuse terms, read on 2026-10-11: the NICE UK Open Content Licence covers use in a UK setting only, international use outside personal research and study needs a licence and a fee, and the NICE terms and conditions make content available for artificial intelligence purposes only through an approval process, a licence and a fee for international use. This pipeline uses AI agents to read the page, so Ben decided on 2026-10-13 that public pages cite and link NICE and use none of its wording.

    3. Background Hypertension in pregnancy: diagnosis and management (NICE guideline NG133), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The version shown on 2026-10-11, with a page header that gives 17 April 2023 as the last update. The same bytes came back on a second fetch minutes later. · Published 2019-06-25 · nice: NG133

      Locator
      Table 6, notes
      How it applies
      How to read the table.
      Retrieved
      Source effective date
      2023-04-17
      Source state
      Current
      Snapshot hash
      0cd8548f5807f03a82b3101dc56ebadf674106da9d0aa7e57955d4a823556fca
      Reuse basis
      The page bytes are not committed. Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE reuse terms, read on 2026-10-11: the NICE UK Open Content Licence covers use in a UK setting only, international use outside personal research and study needs a licence and a fee, and the NICE terms and conditions make content available for artificial intelligence purposes only through an approval process, a licence and a fee for international use. This pipeline uses AI agents to read the page, so Ben decided on 2026-10-13 that public pages cite and link NICE and use none of its wording.

    4. Background Hypertension in pregnancy: diagnosis and management (NICE guideline NG133), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The version shown on 2026-10-11, with a page header that gives 17 April 2023 as the last update. The same bytes came back on a second fetch minutes later. · Published 2019-06-25 · nice: NG133

      Locator
      Table 6, row Stroke, gestational hypertension column
      How it applies
      Not every cell says the risk is increased.
      Retrieved
      Source effective date
      2023-04-17
      Source state
      Current
      Snapshot hash
      0cd8548f5807f03a82b3101dc56ebadf674106da9d0aa7e57955d4a823556fca
      Reuse basis
      The page bytes are not committed. Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE reuse terms, read on 2026-10-11: the NICE UK Open Content Licence covers use in a UK setting only, international use outside personal research and study needs a licence and a fee, and the NICE terms and conditions make content available for artificial intelligence purposes only through an approval process, a licence and a fee for international use. This pipeline uses AI agents to read the page, so Ben decided on 2026-10-13 that public pages cite and link NICE and use none of its wording.

    5. Background Hypertension in pregnancy: diagnosis and management (NICE guideline NG133), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The version shown on 2026-10-11, with a page header that gives 17 April 2023 as the last update. The same bytes came back on a second fetch minutes later. · Published 2019-06-25 · nice: NG133

      Locator
      Table 6, row Hypertension, gestational hypertension and chronic hypertension columns
      How it applies
      The chronic hypertension cell is marked not applicable.
      Retrieved
      Source effective date
      2023-04-17
      Source state
      Current
      Snapshot hash
      0cd8548f5807f03a82b3101dc56ebadf674106da9d0aa7e57955d4a823556fca
      Reuse basis
      The page bytes are not committed. Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE reuse terms, read on 2026-10-11: the NICE UK Open Content Licence covers use in a UK setting only, international use outside personal research and study needs a licence and a fee, and the NICE terms and conditions make content available for artificial intelligence purposes only through an approval process, a licence and a fee for international use. This pipeline uses AI agents to read the page, so Ben decided on 2026-10-13 that public pages cite and link NICE and use none of its wording.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

  • Claim, not a settled fact Hypertensive disorders of pregnancy are associated with a higher later risk of hypertension and cardiovascular disease (NICE NG133 1.10.2): Hypertension (high blood pressure) (Associated with a higher risk of)

    Applies to Maternal
    • Women who have had any hypertensive disorder of pregnancy (chronic hypertension, gestational hypertension or pre-eclampsia), compared by NICE with women who did not have one. The risks NICE reports are overall estimates drawn from several studies.
    • Advice at transfer to community care after a hypertensive disorder of pregnancy.
    • England. NICE's terms and conditions present the information on its websites as support for people in England who make decisions about funding care (clause 6) and say it is not written as a basis for decisions outside the United Kingdom (clause 8). The guideline page states no jurisdiction of its own.
    • Postpartum and later life
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up NICE gives no single follow-up time: it says follow-up in the underlying studies ranged from 1 to 40 years postpartum.
    NICE (recommendation 1.10.2) tells clinicians to explain to women who had any type of hypertensive disorder during pregnancy that these disorders are linked with a raised chance of hypertension and cardiovascular disease as they get older. NICE’s Table 6 gives approximate sizes of the increase for each type of disorder.

    Limitations. This is guidance that summarises other studies, not a new analysis. It covers any hypertensive disorder of pregnancy, so it must not be read as pre-eclampsia alone carrying the risk; Table 6 has separate columns for pre-eclampsia, gestational hypertension and chronic hypertension, and some cells say the risk may be increased or give no data. NICE says the figures in the table are overall estimates that condense results reported as risk, odds or hazard ratios, and that the comparison group is women who did not have a hypertensive disorder in pregnancy. Table 6 marks the later-hypertension row as not applicable for chronic hypertension. The table gives no absolute risks, since they depend on the follow-up time. The page does not state a jurisdiction; England is inferred from the issuer.

  • Claim, not a settled fact Recommended for this: Antihypertensive drug treatment for non-severe hypertension in pregnancy (Recommended for, seen from the other side)

    Applies to Maternal
    • Pregnant women with hypertension who are being treated with medicines. The recommendation says hypertension in pregnancy and sits in the NICE section on chronic hypertension. NICE’s management tables for gestational hypertension (recommendation 1.4.3, Table 1) and pre-eclampsia (recommendation 1.5.5, Table 2) also give a target of 135/85 mmHg or less once on treatment. The NG133 Context chapter says the update did not review treatment for the three types of hypertension in pregnancy as one group. NICE defines hypertension as 140 mmHg systolic or higher, or 90 mmHg diastolic or higher, and severe hypertension as over 160 mmHg systolic or over 110 mmHg diastolic.
    • Maternity care; the recommendation does not name a setting.
    • England. NICE's terms and conditions present the information on its websites as support for people in England who make decisions about funding care (clause 6) and say it is not written as a basis for decisions outside the United Kingdom (clause 8). The guideline page states no jurisdiction of its own.
    • Pregnancy
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    NICE advises that when medicines are used to treat hypertension in pregnancy, the aim is a target blood pressure of 135/85 mmHg. NICE marks this recommendation as one it reviewed in 2019. NICE’s management tables for gestational hypertension and for pre-eclampsia give the same target, 135/85 mmHg or less.

    Limitations. NICE’s target of 135/85 mmHg differs from the goal used in the CHAP trial (below 140/90 mm Hg); the atlas records both and does not reconcile them. This record has not checked whether NICE considered CHAP. The update information lists the April 2023 changes to recommendations 1.3.12 and 1.4.4 only for PlGF-based testing, and does not list 1.3.9. The recommendation sits in the chronic hypertension section while its wording is general; the tables for gestational hypertension and pre-eclampsia carry the same target with the words 135/85 mmHg or less, which 1.3.9 does not use. NICE says its update did not review treatment for the three types of hypertension in pregnancy as one group. NICE gives this recommendation no strength label. The page does not state a jurisdiction; England is inferred from the issuer.

  • Claim, not a settled fact Recommended for this: Antihypertensive drug treatment for non-severe hypertension in pregnancy (Recommended for, seen from the other side)

    Applies to Maternal
    • Pregnant women with non-severe hypertension. WHO uses non-severe and mild to moderate interchangeably and defines them as a diastolic pressure of 90 to 109 mmHg and/or a systolic pressure of 140 to 159 mmHg. The recommendation applies in the context of good quality antenatal care follow-up with regular outpatient monitoring and review.
    • Antenatal care with regular outpatient monitoring and review by an antenatal care provider.
    • Global; WHO states the audience as covering all settings.
    • Pregnancy
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    WHO recommends offering antihypertensive drug treatment to women with non-severe hypertension during pregnancy, as part of good quality antenatal care follow-up. WHO labels it a context-specific recommendation. WHO’s recommendation table gives no numeric blood-pressure target.

    Limitations. Published in 2020, before the CHAP report (2022), so it did not consider CHAP. WHO’s justification says drug treatment probably reduces severe hypertension but may make little or no difference to proteinuria or pre-eclampsia; this is not a GRADE rating of the recommendation, so certainty is not assessed here. WHO also says available evidence suggests calcium channel blockers should be avoided, and its evidence summary lists nifedipine among the calcium channel blockers used in the included trials, while CHAP used extended-release nifedipine as a first-line drug; the atlas records the difference and does not reconcile it. The treatment applies only with regular outpatient monitoring and review.

Record details

Record id
maternal:hypertensive-disorders-of-pregnancy
Content hash
e98d0b788cf5f56d0d4f464681a98f628b2db6dcbeac3528e72ad35454501452