High blood pressure during pregnancy – pregnancy or gestational hypertension
Pregnancy hypertension is the most common complication in pregnancy. It accounts for 30 percent of infant deaths during childbirth and 20 percent of maternal deaths.
Pregnancy hypertension mainly occurs in first-time mothers after the 20th week of pregnancy. It is also more likely in very young mothers-to-be and in multiple pregnancies. Blood pressure then usually stays high until about six weeks after delivery. In practice, blood pressure readings of 140/90 mmHg or higher obtained during two consecutive periods of rest are used as the cut-off. Either the top (systolic) or bottom (diastolic) value can be elevated.
Pregnancy or gestational hypertension without proteinuria (protein in the urine), and pregnancy or gestational hypertension with proteinuria and possible swelling, which is then called preeclampsia.
These two forms are different from high blood pressure that already existed before pregnancy and now causes problems. If new protein appears in the urine on top of pre-existing hypertension, this is called superimposed preeclampsia.
To prevent this, blood pressure is measured at every check-up during pregnancy. This form of high blood pressure also causes hardly any symptoms. Occasionally, affected women notice mild dizziness, feel tired, or have headaches.
The exact cause of preeclampsia is unclear. However, there are some risk factors, such as pre-existing hypertension, diabetes, kidney problems, or cases of preeclampsia among blood relatives, that increase the likelihood of developing it. Scientists suspect problems with the implantation of the embryo because, in preeclampsia, the process by which the arteries in part of the uterus widen to connect with the baby's tissue and form the placenta is disrupted. There are also interactions between the mother's immune system and the developing tissue, as well as changes in prostaglandin balance. The resulting damage to the inner walls of the blood vessels leads to reduced blood flow to the placenta and elevated blood pressure in the expectant mother.
Preeclampsia can progress to eclampsia or HELLP syndrome. Both are serious conditions during pregnancy. That is why blood pressure monitoring is an important part of every prenatal visit.
Even after giving birth, women who had severe pre-eclampsia during pregnancy should keep an eye on their blood pressure. Dutch researchers monitored women during the first year after pregnancy and found that 41 percent of those who had had pre-eclampsia had excessively high blood pressure during that year. Masked hypertension was particularly common: blood pressure readings are normal at the doctor's office but too high outside the doctor's office.
The 2023 guidelines of the ESH (European Society of Hypertension) classify pregnancy complications such as hypertension, pre-eclampsia and diabetes during pregnancy, as well as multiple premature births or miscarriages, as risk factors for developing high blood pressure later in life. Women affected by these conditions should have their blood pressure checked regularly even after pregnancy - and not only once they reach the age of 60 or 65.
In 2024, the German, Austrian and Swiss Societies of Gynaecology and Obstetrics jointly published a new guideline. Among other things, it addresses gestational hypertension. This can be dangerous not only during pregnancy but also means that the mother has an increased risk of developing cardiovascular disease for the rest of her life. The guideline therefore aims to improve the detection and treatment of high blood pressure during pregnancy and to emphasise the importance of follow-up care after giving birth. A follow-up care record was created for affected women to help organise this care more effectively.
The 2023 guidelines of the ESH (European Society of Hypertension) classify pregnancy complications such as hypertension, pre-eclampsia and diabetes during pregnancy, as well as multiple premature births or miscarriages, as risk factors for developing high blood pressure later in life. Women affected by these conditions should have their blood pressure checked regularly even after pregnancy - and not only once they reach the age of 60 or 65.
In 2024, the German, Austrian and Swiss Societies of Gynaecology and Obstetrics jointly published a new guideline. Among other things, it addresses gestational hypertension. This can be dangerous not only during pregnancy but also means that the mother has an increased risk of developing cardiovascular disease for the rest of her life. The guideline therefore aims to improve the detection and treatment of high blood pressure during pregnancy and to emphasise the importance of follow-up care after giving birth. A follow-up care record was created for affected women to help organise this care more effectively.
Sources:
- https://www.hochdruckliga.de/fileadmin/downloads/mediziner/leitlinien/Pocket-Leitlinie_Hypertonie_2018.pdf
- http://flexikon.doccheck.com/de/Schwangerschaftshypertonie
- https://www.aerzteblatt.de/nachrichten/89051/Schwangerschaft-Schwere-Praeeklampsie-fuehrt-haeufig-zu-unbemerktem-Bluthochdruck
- https://idw-online.de/en/news817680
- https://journals.lww.com/jhypertension/Fulltext/9900/2023_ESH_Guidelines_for_the_management_of_arterial.271.aspx
- https://register.awmf.org/assets/guidelines/015-018l_S2k_Hypertensive-Erkrankungen-Schwangerschaft-HES-Diagnostik-Therapie_2024-07.pdf
- https://www.aerzteblatt.de/nachrichten/153008/Neue-Leitlinie-zu-Diagnostik-und-Therapie-von-Bluthochdruck-in-der-Schwangerschaft
This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 11/2025).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
