Defining hypertension -Hypertension is systolic or diastolic BP that is raised from normal values. - a diagnosis of hypertension should be confirmed using 24-hour ambulatory blood pressure monitoring (ABPM) as gold standard rather than be based only on measurements of BP taken in clinical situations

De finit io ns o f hy pe r t e nsio n in t he g e ne r a l, no n- pr e g na nt po pula t io n Stage 1 hypertension Blood pressure of 140/90 mmHg or higher - average of 135/85 mmHg or higher Stage 2 hypertension Blood pressure of 160/100 mmHg or higher - average of 150/95 mmHg or higher Severe hypertension Systolic blood pressure is 180 mmHg or higher, or clinical diastolic pressure is 110 mmHg or higher.

De finit io ns o f hy pe r t e nsio n in pr e g na ncy Mild hypertension Diastolic blood pressure 90–99 mmHg, systolic blood pressure 140–149 mmHg.140\90 149\99 Moderate hypertension Diastolic blood pressure 100–109 mmHg, systolic blood pressure 150–159 mmHg. 150\100 159\109 Severe hypertension Diastolic blood pressure 110 mmHg or greater, systolic blood pressure 160 mmHg or greater.160\110 Chronic hypertension -hypertension that is present at the initial visit (booking) - before 20 weeks, -the woman is already taking antihypertensive medication when referred to maternity services. - It can be primary or secondary in aetiology.

Gestational hypertension -new hypertension presenting after 20 weeks without significant proteinuria. Pre-eclampsia This is new hypertension after 20 weeks with significant proteinuria. Severe pre-eclampsia pre-eclampsia severe hypertension and with symptoms, and/or biochemical and/or haematological impairment.

Hypertensive conditions of pregnancy Chronic hypertension - hypertension >140/90 mmHg that existed before pregnancy - known as benign or essential hypertension. - The earlier that hypertension is diagnosed in pregnancy the more likely it is to be pre- existing chronic hypertension -Lack of illness symptoms implies the woman is unlikely to have had her BP measured pre-pregnancy and potentially it is

diagnosed for the first time once she is pregnant. - associated factors, -obesity - black race - family history of hypertension - lifestyle factors such as lack of exercise, alcohol consumption and poor diet with high salt or fat intake.

-The risk of developing chronic hypertension increases with age and it can be primary or secondary in aetiology If this condition is known pre-pregnancy, the women should be directed to pre- conception care. -This is to ascertain the extent of the hypertension, treat the causes and assess co-morbidities such as renal impairment or diabetes mellitus - where the BP may be lower than with hypertension alone, as the risk of cardiovascular disease is greater -

Current medication should be reviewed as angiotensin-converting enzyme (ACE) inhibitors, diuretics and angiotensin receptor blockers (ARB) increase the risk of congenital malformations) and safer alternatives might need to be prescribed