HYPERTENSIVE DISORDERS IN PREGNANCY: FROM PATHOGENESIS TO CLINICAL MANAGEMENT
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6291Keywords:
Hypertension, Pregnancy, Preeclampsia, TreatmentAbstract
Hypertension in pregnancy combines several conditions, such as chronic hypertension, gestational hypertension, unclassified hypertension before delivery, and preeclampsia. According to WHO data, preeclampsia complicates 3-8% of pregnancies and contributes significantly to maternal and neonatal mortality. In recent years, hypertension in pregnancy has been diagnosed more and more frequently, which is associated with the prevalence of conditions such as diabetes, metabolic syndrome, dyslipidemia, and obesity, but also with the increasing average age of women becoming pregnant. The following article discusses the diagnosis, prevention, and non-pharmacological and pharmacological treatment of this condition. The authors also highlight the role of lifestyle modifications during the preconception period in preventing maternal and fetal complications. The safety of pharmacotherapy for both women and newborns is also discussed. In women with preeclampsia, magnesium sulfate should be used to reduce the risk of eclampsia by more than half. The following article is a review of the diagnosis and treatment of hypertensive disorders occurring during pregnancy.
References
World Health Organization. (2025, December 10). Pre-eclampsia. https://www.who.int/news-room/fact-sheets/detail/pre-eclampsia
Bręborowicz, G. (2021). Położnictwo i ginekologia (T. 1–2, wyd. 3). PZWL.
Dimitriadis, E., Rolnik, D. L., Zhou, W., Estrada-Gutierrez, G., Koga, K., Francisco, R. P. V., Whitehead, C., Hyett, J., da Silva Costa, F., Nicolaides, K., & Menkhorst, E. (2023). Pre-eclampsia. Nature Reviews Disease Primers, 9(1), Article 8. https://doi.org/10.1038/s41572-023-00417-6
Levine, R. J., Maynard, S. E., Qian, C., Lim, K., England, L. J., Yu, K. F., Schisterman, E. F., Thadhani, R., Sachs, B. P., Epstein, F. H., Sibai, B. M., Sukhatme, V. P., & Karumanchi, S. A. (2004). Circulating angiogenic factors and the risk of preeclampsia. New England Journal of Medicine, 350(7), 672–683. https://doi.org/10.1056/NEJMoa031884
Feng, H., Wang, L., Zhang, G., Zhang, Z., & Guo, W. (2020). Oxidative stress activated by Keap-1/Nrf2 signaling pathway in pathogenesis of preeclampsia. International Journal of Clinical and Experimental Pathology, 13(3), 382–392.
Tossetta, G., Fantone, S., Piani, F., Crescimanno, C., Ciavattini, A., Giannubilo, S. R., & Marzioni, D. (2023). Modulation of NRF2/KEAP1 signaling in preeclampsia. Cells, 12(11), Article 1545. https://doi.org/10.3390/cells12111545
Raguema, N., Moustadraf, S., & Bertagnolli, M. (2020). Immune and apoptosis mechanisms regulating placental development and vascularization in preeclampsia. Frontiers in Physiology, 11, Article 98. https://doi.org/10.3389/fphys.2020.00098
Raguema, N., Moustadraf, S., & Bertagnolli, M. (2020). Immune and apoptosis mechanisms regulating placental development and vascularization in preeclampsia. Frontiers in Physiology, 11, Article 98. https://doi.org/10.3389/fphys.2020.00098
Figueiredo, A. S., & Schumacher, A. (2016). The T helper type 17/regulatory T cell paradigm in pregnancy. Immunology, 148(1), 13–21. https://doi.org/10.1111/imm.12595
Kamrani, A., Alipourfard, I., Ahmadi-Khiavi, H., Yousefi, M., Rostamzadeh, D., Izadi, M., & Ahmadi, M. (2019). The role of epigenetic changes in preeclampsia. BioFactors, 45(5), 712–724. https://doi.org/10.1002/biof.1542
Hansen, A. T., Jensen, J. M. B., Hvas, A., & Christiansen, M. (2018). The genetic component of preeclampsia: A whole-exome sequencing study. PLOS ONE, 13(5), Article e0197217. https://doi.org/10.1371/journal.pone.0197217
casusBTL, G. (n.d.). Wytyczne ESC 2024 dotyczące postępowania w podwyższonym ciśnieniu tętniczym i nadciśnieniu tętniczym. Polskie Towarzystwo Kardiologiczne. https://ptkardio.pl/wytyczne/1-wytyczne_esc_2024_dotyczace_postepowania_w_podwyzszonym_cisnieniu_tetniczym_i_nadcisnieniu_tetniczym
Prejbisz, A., Dobrowolski, P., Kosiński, P., Bomba-Opoń, D., Adamczak, M., Bekiesińska-Figatowska, M., Kądziela, J., Konopka, A., Kostka-Jeziorny, K., Kurnatowska, I., Leszczyńska-Gorzelak, B., Litwin, M., Olszanecka, A., Orczykowski, M., Poniedziałek-Czajkowska, E., Sobieszczańska-Małek, M., Stolarz-Skrzypek, K., Szczepaniak-Chicheł, L., Szyndler, A., . . . Januszewicz, A. (2019). Management of hypertension in pregnancy—Prevention, diagnosis, treatment and long-term prognosis: A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians. Arterial Hypertension, 23(3), 117–182. https://doi.org/10.5603/AH.a2019.0011
Steegers, E. A., von Dadelszen, P., Duvekot, J. J., & Pijnenborg, R. (2010). Pre-eclampsia. The Lancet, 376(9741), 631–644. https://doi.org/10.1016/S0140-6736(10)60279-6
Young, O. M., Twedt, R., & Catov, J. M. (2016). Pre-pregnancy maternal obesity and the risk of preterm preeclampsia in the American primigravida. Obesity, 24(6), 1226–1229. https://doi.org/10.1002/oby.21412
Brown, M. A., Magee, L. A., Kenny, L. C., Karumanchi, S. A., McCarthy, F. P., Saito, S., Hall, D. R., Warren, C. E., Adoyi, G., & Ishaku, S. (2018). The hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Pregnancy Hypertension, 13, 291–310. https://doi.org/10.1016/j.preghy.2018.05.004
Tan, M. Y., Syngelaki, A., Poon, L. C., Rolnik, D. L., O’Gorman, N., Delgado, J. L., Akolekar, R., Konstantinidou, L., Tsavdaridou, M., Galeva, S., Ajdacka, U., Molina, F. S., Persico, N., Jani, J. C., Plasencia, W., Greco, E., Papaioannou, G., Wright, A., Wright, D., & Nicolaides, K. H. (2018). Screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation. Ultrasound in Obstetrics & Gynecology, 52(2), 186–195. https://doi.org/10.1002/uog.19112
Poon, L. C., & Nicolaides, K. H. (2014). Early prediction of preeclampsia. Obstetrics and Gynecology International, 2014, Article 297397. https://doi.org/10.1155/2014/297397
Gallo, D. M., Wright, D., Casanova, C., Campanero, M., & Nicolaides, K. H. (2016). Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 19–24 weeks’ gestation. American Journal of Obstetrics and Gynecology, 214(5), 619.e1–619.e17. https://doi.org/10.1016/j.ajog.2015.11.016
Agrawal, S., Cerdeira, A. S., Redman, C., & Vatish, M. (2018). Meta-analysis and systematic review to assess the role of soluble FMS-like tyrosine kinase-1 and placenta growth factor ratio in prediction of preeclampsia. Hypertension, 71(2), 306–316. https://doi.org/10.1161/HYPERTENSIONAHA.117.10182
Ramlakhan, K. P., Roos-Hesselink, J. W., Basso, T., Greenslade, J., Flint, R. B., Krieger, E. V., Shotan, A., Budts, W., de Backer, J., Hall, R., Johnson, M. R., & Parsonage, W. A. (2024). Perinatal outcomes after in-utero exposure to beta-blockers in women with heart disease: Data from the ESC EORP Registry of Pregnancy and Cardiac Disease (ROPAC). International Journal of Cardiology, 410, Article 132234. https://doi.org/10.1016/j.ijcard.2024.132234
Leonard, S. A., Siadat, S., Huybrechts, K. F., Main, E. K., Hlatky, M. A., Hernández-Díaz, S., & Bateman, B. T. (2025). Comparative effectiveness and safety of labetalol versus nifedipine for treatment of chronic hypertension during pregnancy. JACC: Advances, 4(9), Article 102054. https://doi.org/10.1016/j.jacadv.2025.102054
Nayak, A. S., & Nachane, H. B. (2018). Risk analysis of suicidal ideations and postpartum depression with antenatal alpha methyldopa use. Asian Journal of Psychiatry, 38, 42–44. https://doi.org/10.1016/j.ajp.2018.10.024
Witlin, A. (1998). Magnesium sulfate therapy in preeclampsia and eclampsia. Obstetrics & Gynecology, 92(5), 883–889. https://doi.org/10.1016/S0029-7844(98)00277-4
Leszczyńska-Gorzelak, B., & Mierzyński, R. (2026, May 25). Przewlekłe nadciśnienie tętnicze a ciąża. Podyplomie. https://podyplomie.pl/ginekologia/31231,przewlekle-nadcisnienie-tetnicze-a-ciaza
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Maria Sierant, Kornelia Tyczka, Zofia Cepowska, Maria Nowakowska

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

