Table 2.

Target organ damage due to chronic hypertension

OrganPathologyAssessmentConsiderations in pregnancy
HeartLeft ventricular hypertrophy/remodelling
Impaired cardiac function
Ischaemic heart disease
Clinical examination
ECG
Echo
30–50% increase in cardiac output required for pregnancy
Cardiac disease is commonest cause of maternal death in UK
KidneysAlbuminuria
Proteinuria
Hypertensive nephropathy
Chronic kidney disease
uACR/uPCR
Serum creatinine
uACR >8 mg/mmol, uPCR >30 mg/mmol and serum creatinine >77 μmol/L are abnormal in pregnancy6
CKD confers risk of adverse pregnancy outcome and loss of maternal kidney function
Retina and brainHypertensive retinopathy
Hypertensive/ischaemic optic neuropathy
FundoscopyConsider hypertensive crisis, warrants inpatient assessment/management
Needs exclusion of secondary hypertension
ArteriesIncreased peripheral arterial stiffness
Atherosclerosis
Consider vascular risk in pregnancy
Serum cholesterol increases in pregnancy and is not routinely checked or treated
  • CKD = chronic kidney disease; ECG = electrocardiography; Echo = echocardiography; uACR = urinary albumin:creatinine ratio, uPCR = urinary protein:creatinine ratio.