Table 12.

BIHS position: Management of severe hypertension (with or without preeclampsia) associated with pregnancy.

Hypertensive emergency state	Antihypertensive management in severe pre-eclampsia/severe hypertension in pregnancy
Principles of treatment	Balancing the risk of development of eclampsia and acute hypertensive complications in the mother and delaying delivery to term (based on the possibility of prolonging gestation to allow the foetus more time to mature)
Pace of BP reduction and BP targets	1. As a first step reduce BP to <160/110 mmHg, then consider BP target ≤135/85 mmHg.
	2. If superimposed on chronic hypertension a target related to pre-pregnancy or booking BP may be more appropriate.
	3. If severe hypertension (>200/120 mmHg) a target of around 160/110 mmHg may be more appropriate. Avoid rapid drops in BP in this case while monitoring clinical and renal parameters.
	(Monitor maternal and foetal parameters closely throughout).
Medications	Labetalol, nifedipine, methyldopa, and hydralazine are considered safe during pregnancy. IV medications are easier to titrate to BP response and target especially in severe hypertension. All women should be offered routine post-natal follow-up to ensure that BP and proteinuria return to normal.