Is a 20-point increase in blood pressure (BP) from 90/60 to 110/80 during pregnancy considered hypertension, even if it's below 140/90?

Blood Pressure Rise During Pregnancy: Absolute Values Define Hypertension, Not Relative Changes

No, a 20-point increase in blood pressure from 90/60 to 110/80 during pregnancy is NOT considered hypertension because the absolute values remain below the diagnostic threshold of 140/90 mmHg. 1 Current guidelines define hypertension in pregnancy based on absolute blood pressure measurements, not on relative increases from baseline values.

Diagnostic Criteria for Hypertension in Pregnancy

The diagnosis of hypertension during pregnancy is straightforward and based solely on absolute thresholds:

• Hypertension is diagnosed when systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, confirmed on at least 2 separate occasions or at least 15 minutes apart in severe cases 1
• A blood pressure of 110/80 mmHg falls well within the normal range and requires no treatment, regardless of the baseline value 1

This absolute threshold approach is consistent across all major international guidelines, including the 2024 European Society of Cardiology guidelines and the 2020 ESC Council on Hypertension position paper 1.

Why Relative Changes Are Not Used

While a 20-point rise might seem significant, modern obstetric guidelines have abandoned the historical practice of diagnosing hypertension based on relative increases from baseline 1. This shift occurred because:

• Absolute blood pressure values correlate more reliably with adverse maternal outcomes (stroke, pulmonary edema, eclampsia) 1
• The evidence base for treatment thresholds is built on absolute BP measurements, not relative changes 1
• Using relative criteria would lead to overdiagnosis and unnecessary treatment in women with physiologically low baseline pressures 1

Treatment Thresholds During Pregnancy

Understanding when to initiate treatment is critical:

For Gestational Hypertension or High-Risk Conditions

• Initiate drug treatment at BP ≥140/90 mmHg in women with gestational hypertension, pre-existing hypertension with superimposed gestational hypertension, or hypertension with subclinical organ damage 1, 2
• Target diastolic BP of 85 mmHg and systolic BP between 110-140 mmHg 2, 3, 4

For Uncomplicated Chronic Hypertension

• Initiate treatment at BP ≥150/95 mmHg in all other pregnant women without the above features 1

For Severe Hypertension (Emergency)

• BP ≥160/110 mmHg requires immediate hospitalization and treatment within 15 minutes to prevent maternal stroke 1, 3
• First-line agents: IV labetalol, oral immediate-release nifedipine, or IV hydralazine 1, 3, 4

Clinical Monitoring for Your Patient

For a patient whose BP rises from 90/60 to 110/80:

• No antihypertensive treatment is indicated as values remain normal 1
• Continue routine prenatal monitoring with BP checks at each visit 3
• Monitor for progression to true hypertension (≥140/90 mmHg), which would then require evaluation for gestational hypertension 2, 3
• Screen for proteinuria if BP reaches ≥140/90 mmHg, as approximately 25% of gestational hypertension cases progress to preeclampsia 2, 3

Common Pitfall to Avoid

Do not treat based on relative BP changes or "trends" when absolute values remain normal. 1 This leads to unnecessary medication exposure during pregnancy and potential harm from overtreatment, including fetal growth concerns and maternal hypotension 4. The evidence-based approach focuses exclusively on absolute BP thresholds that correlate with maternal and fetal morbidity and mortality 1.