The following is a summary of secondary care management recommended by the National Institute for Health and Clinical Excellence (NICE).

• Women with severe hypertension will be admitted.
• Blood pressure will be measured four times a day. The woman will be kept in hospital until her blood pressure is 159/109 mmHg or lower.
• Blood will be taken to test for kidney function, electrolytes, full blood count, transaminases and bilirubin on presentation.
• Urine will be tested for protein using automated dipsticks or urinary protein:creatinine ratio.
• Antihypertensive medication will be prescribed:
• Labetalol is the first choice.
• Methyldopa and nifedipine are alternatives after consideration of the adverse effect profile for the mother and the fetus.
• Follow up
• Once blood pressure has fallen to 159/109 mmHg or lower, women will be followed up in outpatients/an early pregnancy assessment centre with twice-weekly blood pressure monitoring; twice-weekly automated dipstick testing for protein: and once-weekly blood tests for urea and electrolytes, full blood count, transaminases, and bilirubin.
• Birth before 37 weeks will only be offered to women with refractory severe hypertension after a course of antenatal steroids (if required) has been completed.
• Women with moderate hypertension will be managed and followed up in an outpatient setting or at a pregnancy assessment centre.
• Blood will be taken for urea and electrolytes, full blood count, transaminases, and bilirubin, if not already done by the GP on presentation.
• Antihypertensive medication will be prescribed:
• Labetalol is the first choice.
• Methyldopa and nifedipine are alternatives after consideration of the adverse effect profile for the mother and the fetus.
• Follow up
• Will be in outpatients/a pregnancy assessment unit with twice-weekly blood pressure monitoring, and twice-weekly testing of urine for protein using automated dipsticks or urinary protein:creatinine ratio.
• Further blood tests will not be performed unless the woman develops proteinuria.
• Women with mild hypertension will be managed and followed up in an outpatient setting or at a pregnancy assessment centre.
• Blood tests other than those done for routine antenatal care will not be needed.
• Monitoring will be as follows:
• If presenting before 32 weeks, or if at high risk of pre-eclampsia, the woman will have blood pressure monitoring and testing of urine for protein using automated dipsticks or urinary protein:creatinine ratio twice a week.
• If presenting after 32 weeks and not at high risk of pre-eclampsia, the woman will have blood pressure and urine checked for protein using automated dipsticks or urinary protein:creatinine ratio not more often than once per week.
• Bed rest in hospital is not recommended as a treatment for gestational hypertension.
• Aspirin 75 mg daily will be prescribed until the birth of the baby only if the woman has either:
• One or more high risk factors for pre-eclampsia.
• Two or more for moderate risk factors for pre-eclampsia.