Preeclampsia vs Chronic and gestational hypertension
How to tell Preeclampsia and Chronic and gestational hypertension apart when a board question makes them look alike.
Preeclampsia has after-20-week hypertension plus proteinuria/end-organ signs; chronic HTN starts before 20 weeks; gestational HTN lacks proteinuria and severe features.
Side by side
Preeclampsia is hypertension after 20 weeks with proteinuria or end-organ features such as renal injury, thrombocytopenia, liver injury, pulmonary edema, headache, or visual symptoms.
Chronic hypertension predates pregnancy or appears before 20 weeks; gestational hypertension appears after 20 weeks without proteinuria or severe end-organ findings.
Preeclampsia arises from abnormal placentation with systemic endothelial dysfunction and maternal organ injury.
Chronic hypertension reflects preexisting vascular disease, while gestational hypertension is pregnancy-onset blood pressure elevation without preeclamptic organ injury.
Proteinuria, low platelets, elevated creatinine, transaminitis, pulmonary edema, or neurologic symptoms support preeclampsia.
Hypertension before 20 weeks or known prepregnancy hypertension supports chronic hypertension; isolated later hypertension supports gestational hypertension.
The trap
Timing alone is not enough after 20 weeks because gestational hypertension and preeclampsia separate by proteinuria and organ injury.
The repair move
For pregnancy hypertension, combine timing with proteinuria and severe-feature labs.
Try a free question
CoreA 27-year-old G1 at 29 weeks gestation has BP 148/96 mm Hg confirmed on a repeat reading 6 hours later. Urine protein/creatinine ratio is 0.12 (normal <0.3). Platelets, creatinine, and transaminases are normal. She has no headache, vision changes, or epigastric pain. Which diagnosis is most appropriate?
Show answer and explanation
Answer: A. Gestational hypertension. New-onset hypertension after 20 weeks without proteinuria or end-organ involvement defines gestational hypertension; it can progress to preeclampsia and requires surveillance.
Why the other choices are tempting
- B. Preeclampsia requires proteinuria or end-organ involvement; this patient has neither.
- C. Chronic hypertension is hypertension predating pregnancy or detected before 20 weeks; this is first seen at 29 weeks.
- D. White-coat hypertension would resolve at home; the elevation is sustained on repeat measurement.
- E. Pheochromocytoma is rare and would typically have episodic adrenergic spells with markedly elevated catecholamines, not stable second-trimester hypertension.
Flashcards
Tap a card to flip it.
What timing supports chronic hypertension in pregnancy?
Hypertension before 20 weeks or before pregnancy supports chronic hypertension.
What distinguishes gestational hypertension from preeclampsia?
Gestational hypertension lacks proteinuria and severe end-organ features.
Quick answers
What is the fastest way to tell Preeclampsia from Chronic and gestational hypertension?
Preeclampsia has after-20-week hypertension plus proteinuria/end-organ signs; chronic HTN starts before 20 weeks; gestational HTN lacks proteinuria and severe features.
What is the key clue for Preeclampsia?
Preeclampsia is hypertension after 20 weeks with proteinuria or end-organ features such as renal injury, thrombocytopenia, liver injury, pulmonary edema, headache, or visual symptoms.
What is the key clue for Chronic and gestational hypertension?
Chronic hypertension predates pregnancy or appears before 20 weeks; gestational hypertension appears after 20 weeks without proteinuria or severe end-organ findings.
What is the common trap with Preeclampsia vs Chronic and gestational hypertension?
Timing alone is not enough after 20 weeks because gestational hypertension and preeclampsia separate by proteinuria and organ injury.