Gestational HTN vs Chronic HTN in pregnancy
How to tell Gestational HTN and Chronic HTN in pregnancy apart when a board question makes them look alike.
Step 2 CK pairs are in open beta while clinical review finishes. Spot an issue? Tell us.
Hypertension first appearing after 20 weeks is gestational until proven otherwise.
Side by side
New hypertension after 20 weeks without proteinuria or end-organ injury indicates gestational hypertension.
Hypertension known before pregnancy or first detected before 20 weeks indicates chronic hypertension in pregnancy.
Placental and vascular maladaptation in later pregnancy can cause new elevated blood pressure without severe multisystem disease.
Preexisting vascular disease or essential hypertension persists into pregnancy and increases superimposed preeclampsia risk.
Blood pressure at least 140/90 mm Hg on two readings at least 4 hours apart after 20 weeks with urine protein-creatinine ratio below 0.3 and normal platelets, creatinine, and liver enzymes supports gestational hypertension.
Persistent BP at least 140/90 mm Hg before 20 weeks or documented prepregnancy hypertension supports chronic disease; baseline creatinine and urine protein are obtained to track for superimposed preeclampsia.
The trap
A common mistake is labeling all third-trimester hypertension as preeclampsia. The resolving clue is absence of proteinuria and severe features, which supports gestational hypertension.
The repair move
Next best step: classify as gestational hypertension, begin close maternal-fetal surveillance with weekly blood pressure and symptom review, periodic labs, and fetal growth monitoring. Start antihypertensive therapy if BP reaches severe range at least 160/110 mm Hg and plan delivery at 37 weeks if no severe features develop.
Try a free question
CoreA 28-year-old patient at 32 weeks has two blood pressure readings of 144/92 mm Hg and 142/90 mm Hg. Platelets, creatinine, AST, and urine protein-creatinine ratio are normal. What is the most likely diagnosis?
Show answer and explanation
Answer: A. Gestational hypertension. New-onset hypertension after 20 weeks without proteinuria or severe features is gestational hypertension.
Why the other choices are tempting
- B. Chronic hypertension is diagnosed before pregnancy or before 20 weeks.
- C. Severe-feature preeclampsia requires organ dysfunction or severe pressures not present here.
- D. Eclampsia requires seizures.
- E. Repeated elevated readings in clinic with objective data are not simply white coat effect.
Flashcards
Tap a card to flip it.
What gestational age threshold separates gestational from chronic hypertension in pregnancy classification?
The 20-week mark. New hypertension after 20 weeks suggests gestational hypertension.
Which urine threshold helps exclude preeclampsia in a hypertensive pregnant patient?
Protein-creatinine ratio below 0.3 argues against proteinuric preeclampsia.
Quick answers
What is the fastest way to tell Gestational HTN from Chronic HTN in pregnancy?
Hypertension first appearing after 20 weeks is gestational until proven otherwise.
What is the key clue for Gestational HTN?
New hypertension after 20 weeks without proteinuria or end-organ injury indicates gestational hypertension.
What is the key clue for Chronic HTN in pregnancy?
Hypertension known before pregnancy or first detected before 20 weeks indicates chronic hypertension in pregnancy.
What is the common trap with Gestational HTN vs Chronic HTN in pregnancy?
A common mistake is labeling all third-trimester hypertension as preeclampsia. The resolving clue is absence of proteinuria and severe features, which supports gestational hypertension.