Hypertensive disorders of pregnancy: A comprehensive review of pathophysiology, diagnosis, treatment, and long-term cardiovascular implications.

Abstract

Hypertensive disorders of pregnancy (HDP) are common and clinically consequential, affecting ~5%-10% of pregnancies and contributing substantially to maternal and perinatal morbidity and mortality. This review summarizes key concepts that inform bedside decision-making, including contemporary classification, major pathophysiologic pathways (placental dysfunction, endothelial injury, and systemic inflammation), and diagnostic criteria to support timely recognition and risk stratification. Clinically, early identification of preeclampsia and prompt management of severe hypertension and acute complications are central to reducing preventable harm. We highlight evidence-based treatment strategies, focusing on blood pressure control, monitoring for maternal-fetal deterioration, and coordinated multidisciplinary care. Beyond pregnancy, women with prior HDP face elevated long-term cardiovascular risk; therefore, structured postpartum follow-up, cardiovascular risk assessment, and preventive interventions are essential. By integrating current guidelines with recent evidence, this article provides practical recommendations to improve short-term maternal-fetal outcomes and long-term cardiovascular health.