A pregnant patient has blood pressure of 180/95 at 18 weeks and 170/95 one week later with ankle edema but no protein in urine. How would this be classified?

A pregnant patient has blood pressure of 180/95 at 18 weeks and 170/95 one week later with ankle edema but no protein in urine. How would this be classified?

• A. Preeclampsia
• B. Chronic hypertension
• C. Chronic hypertension with superimposed preeclampsia
• D. Gestational hypertension

Answer: (B)

The key concept is that the timing of hypertension onset in pregnancy, together with proteinuria or end-organ signs, defines the diagnosis. Hypertension that appears before 20 weeks is considered chronic hypertension, not a gestational condition. Preeclampsia and gestational hypertension are conditions that require high blood pressure to develop after 20 weeks. In this scenario, the blood pressure elevations occur at 18 weeks and persist a week later, but there is no protein in the urine and no end-organ dysfunction. Edema can occur in normal pregnancy and by itself does not establish preeclampsia. Therefore, this pattern fits chronic hypertension. If proteinuria or other signs of end-organ impact developed after 20 weeks, it would raise concern for superimposed preeclampsia; if the hypertension had begun after 20 weeks with no proteinuria, gestational hypertension would be considered.

The key concept is that the timing of hypertension onset in pregnancy, together with proteinuria or end-organ signs, defines the diagnosis. Hypertension that appears before 20 weeks is considered chronic hypertension, not a gestational condition. Preeclampsia and gestational hypertension are conditions that require high blood pressure to develop after 20 weeks. In this scenario, the blood pressure elevations occur at 18 weeks and persist a week later, but there is no protein in the urine and no end-organ dysfunction. Edema can occur in normal pregnancy and by itself does not establish preeclampsia. Therefore, this pattern fits chronic hypertension. If proteinuria or other signs of end-organ impact developed after 20 weeks, it would raise concern for superimposed preeclampsia; if the hypertension had begun after 20 weeks with no proteinuria, gestational hypertension would be considered.