Table 2.

Guidelines for diagnosis and treatment of Hypertensive Disorders of Pregnancy (adapted from Moser M et al, 2012)

Definitions and BP treatment levels	SOGC [16]	ESH/ESC [23, 24]	NICE [25]	SOMANZ [19]
Definitions of hypertension in pregnancy	A. Pre-existing hypertension (before pregnancy or < 20 wks.) (1) with co morbid conditions (2) with preeclampsia (hypertension, proteinuria, and adverse conditions, > 20 weeks’ gestation) B. Gestational hypertension (≥20 wks.) (1) with co morbid conditions (2) with preeclampsia (hypertension, proteinuria, and adverse conditions)	A. Pre-existing hypertension B. Preeclampsia - gestational hypertension with significant proteinuria C. Gestational hypertension D. Pre-existing hypertension plus superimposed gestational hypertension with proteinuria E. Antenatally unclassifiable hypertension - postpartum re-classified as (1) gestational hypertension with or without proteinuria (2) pre- existing hypertension	A. Primary or Secondary chronic hypertension < 20 weeks’ gestation or on antihypertensive meds before referral to maternity service B. Preeclampsia- new hypertension > 20 weeks with significant proteinuria (1) mild, (2) moderate, (3) severe hypertension Eclampsia (convulsive condition associated with preeclampsia) C. Gestational hypertension new hypertension > 20 weeks without significant proteinuria (1) mild, (2) moderate, (3) severe hypertension	A. Chronic hypertension (1) essential, (2) secondary, or (3) white coat B. Preeclampsia- eclampsia C. Gestational hypertension D. Preeclampsia superimposed upon chronic hypertension
Recommended BP treatment levels	Severe hypertension (>160/≥110 mm Hg), BP should be lowered to <160 mm Hg SBP and < 110 mm Hg DBP (II-2B) Non severe hypertension (140–159/90–109 mm Hg), BP should be lowered to 130– 155 mm Hg SBP and 80–105 mm Hg DBP, when there are no co morbid conditions (III-C) For women with comorbidities, SBP should be lowered to 130–139 mm Hg, and DBP to 80– 89 mm Hg (III-C)	Drug treatment of severe hypertension in pregnancy (SBP >160 mmHg or DBP >110 mmHg) is recommende d. (IC)^ Drug treatment may also be considered in pregnant women with persistent elevation of BP ≥150/95 mmHg, and in those with BP ≥140/90 mmHg in the presence of gestational hypertension, subclinical organ damage or symptoms. (IIbC)	In pregnant women with uncomplicated chronic hypertension aim to keep blood pressure lower than 150/100 mmHg. Do not lower diastolic blood pressure below 80 mmHg. Offer pregnant women with target-organ damage secondary to chronic hypertension (for example, kidney disease) treatment with the aim of keeping blood pressure lower than 140/90 mmHg. In preeclampsia and gestational hypertension, treat only if BP ≥ 150/100 mmHg	Antihypertensive treatment be commenced in all women with SBP ≥ 170 mm Hg or DBP ≥110 mm Hg Treatment for mild to moderate hypertension of 140–160/90– 100 mm Hg is optional and will reflect local practice

SOGC, Society of Obstetricians and Gynaecologists of Canada; ESH/ESC, European Society of Hypertension /European Society of Cardiology; NICE, National Institute for Health and Clinical Excellence; SOMANZ, Society of Obstetric Medicine of Australia and New Zealand. The abbreviations/key codes in parentheses represent the ranking of evidence and grading of recommendations used by the SOGC and the ESH/ESC. An explanation of these can be found in the appendices.