{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T11:05:00Z","timestamp":1773399900765,"version":"3.50.1"},"reference-count":50,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>The management of hypertensive disease in pregnancy is currently guided by practice recommendations based largely on observational data from a half century ago and has changed only superficially since that time. These recommendations are both narrowly prescriptive (women without traditional features of severe disease should all be delivered at exactly 370\/7 weeks) and at the same time frustratingly ambiguous (the presence of epigastric pain unresponsive to repeat analgesics precludes expectant management at any gestational age, regardless of laboratory studies). Guidelines that ignore recent data from the obstetric, pediatric, and internal medicine literature too often lead practitioners to be more aggressive than necessary in the delivery of very premature pregnancies, and, conversely, more complacent than patient safety would support in prolonging pregnancy with advanced fetal maturity. We present here an alternative, organ-specific-based approach to the management of gestational hypertension that allows and encourages practitioners to formulate a management plan based on a thoughtful and, when possible, evidence-based synthesis of the continuous variables of blood pressure, degree of organ dysfunction and response to treatment, gestational age, and patient balancing of maternal and fetal\/neonatal risks. Such clinical care is more complex and nuanced than simply basing life-altering critical management decisions, including timing of delivery, on whether the patient does, or does not have any one of the conditions described by box 4 of the current American College of Obstetricians and Gynecologists practice guidelines. Nonetheless, we believe this approach will not only improve care but will also open the door to useful investigations into prevention and management of the various entities traditionally considered as the same disease process.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2459-8748","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T01:12:33Z","timestamp":1730769153000},"page":"546-554","source":"Crossref","is-referenced-by-count":1,"title":["An Organ-Specific Approach to the Management of Gestational Hypertension: Evidence versus Tradition"],"prefix":"10.1055","volume":"42","author":[{"given":"Steven L.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Nephrology, Neurology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George A.","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary C.","family":"Tolcher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Nephrology, Neurology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Nephrology, Neurology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dwight J.","family":"Rouse","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert M.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avni","family":"Kapadia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan C.","family":"Sundgren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai K.","family":"Saridey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baha M.","family":"Sibai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,11,25]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/AOG.0000000000000965","article-title":"The anachronistic terminology of pregnancy induced hypertension: time for a change","volume":"126","author":"S L Clark","year":"2015","journal-title":"Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"S786","DOI":"10.1016\/j.ajog.2021.12.001","article-title":"Preeclampsia and eclampsia: the conceptual evolution of a syndrome","volume":"226","author":"O Erez","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/ki.1980.134","article-title":"Management of preeclampsia and eclampsia","volume":"18","author":"J A Pritchard","year":"1980","journal-title":"Kidney Int"},{"key":"ref4","volume-title":"Williams Obstetrics, 15th ed","author":"J A Pritchard","year":"1976"},{"issue":"9237","key":"ref5","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/S0140-6736(00)02800-2","article-title":"Pre-eclampsia","volume":"356","author":"J J Walker","year":"2000","journal-title":"Lancet"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"440.e1","DOI":"10.1016\/j.ajog.2023.12.038","article-title":"Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?","volume":"230","author":"K S Joseph","year":"2024","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1161\/HYPERTENSIONAHA.121.17661","article-title":"Historical and recent changes in maternal mortality due to hypertensive disorders in the United States, 1979 to 2018","volume":"78","author":"C V Ananth","year":"2021","journal-title":"Hypertension"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"e2023064153","DOI":"10.1542\/peds.2023-064153","article-title":"Trends in mortality and morbidities for infants born 24\u201328 weeks in the U.S: 1997\u20132021","volume":"153","author":"J D Horbar","year":"2024","journal-title":"Pediatrics"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"e023004","DOI":"10.1136\/bmjopen-2018-023004","article-title":"Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study","volume":"9","author":"L L Richter","year":"2019","journal-title":"BMJ Open"},{"issue":"10","key":"ref11","first-page":"1039","article-title":"Trends in care practices, morbidity and mortality of extremely premature neonates","volume":"314","author":"B J Stoll","year":"2015","journal-title":"JAMA"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"103.e1","DOI":"10.1016\/j.ajog.2016.01.004","article-title":"Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort","volume":"215","author":"T A Manuck","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.ajog.2022.11.1280","article-title":"Gestational hypertension and \u201csevere\u201d disease: time for a change","volume":"228","author":"S L Clark","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"ref14","volume-title":"Hypertension in Harrison's Principles of Internal Medicine","author":"T A Kotchen","year":"2022","edition":"21st ed.,"},{"issue":"06","key":"ref15","first-page":"e237","article-title":"American College of Obstetricians and Gynecologists practice bulletin #222. Gestational hypertension and pre eclampsia. Interim update","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/s41588-020-0617-2","article-title":"Calling it what it is","volume":"52","year":"2020","journal-title":"Nat Genet"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/AOG.0b013e3181e24f28","article-title":"Rethinking the definition of \u201cterm pregnancy\u201d","volume":"116","author":"A R Fleischman","year":"2010","journal-title":"Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1097\/AOG.0000000000000485","article-title":"When do women deliver? The impact of obstetrical intervention on temporal patterns of childbirth","volume":"124","author":"S L Clark","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"15","key":"ref21","doi-asserted-by":"crossref","first-page":"e14982","DOI":"10.14814\/phy2.14982","article-title":"Losing the dogmatic view of cerebral autoregulation","volume":"9","author":"P Brassard","year":"2021","journal-title":"Physiol Rep"},{"issue":"09","key":"ref22","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.ajem.2015.05.036","article-title":"Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort","volume":"33","author":"P D Levy","year":"2015","journal-title":"Am J Emerg Med"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/HJH.0b013e3282f4e8b6","article-title":"Association between hypertensive urgencies and subsequent cardiovascular events in patients with hypertension","volume":"26","author":"M Vlcek","year":"2008","journal-title":"J Hypertens"},{"issue":"07","key":"ref24","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1001\/jamainternmed.2016.1509","article-title":"Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting","volume":"176","author":"K K Patel","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"19","key":"ref25","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1056\/NEJMoa2201295","article-title":"Treatment for mild chronic hypertension during pregnancy","volume":"386","author":"A T Tita","year":"2022","journal-title":"N Engl J Med"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1053\/j.ajkd.2012.11.030","article-title":"Proteinuria and life expectancy","volume":"61","author":"T C Turin","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"ref27","volume-title":"Acute kidney injury","author":"S S Waikar","year":"2022"},{"issue":"9843","key":"ref28","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0140-6736(11)61454-2","article-title":"Acute kidney injury","volume":"380","author":"R Bellomo","year":"2012","journal-title":"Lancet"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00134-017-4809-x","article-title":"Renal recovery after acute kidney injury","volume":"43","author":"L G Forni","year":"2017","journal-title":"Intensive Care Med"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1001\/jama.2018.17948","article-title":"Serum creatinine levels before, during and after pregnancy","volume":"321","author":"Z Harel","year":"2019","journal-title":"JAMA"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/0002-9378(88)90003-8","article-title":"Clinical indications for pulmonary artery catheterization in the patient with severe preeclampsia","volume":"158","author":"S L Clark","year":"1988","journal-title":"Am J Obstet Gynecol"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1016\/S0140-6736(22)01439-8","article-title":"Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management","volume":"400","author":"E A Gorman","year":"2022","journal-title":"Lancet"},{"issue":"26","key":"ref33","doi-asserted-by":"crossref","first-page":"2788","DOI":"10.1056\/NEJMcp052699","article-title":"Clinical practice. Acute pulmonary edema","volume":"353","author":"L B Ware","year":"2005","journal-title":"N Engl J Med"},{"issue":"02","key":"ref34","first-page":"227","article-title":"Pulmonary edema associated with pregnancy: echocardiographic insights and implications for treatment","volume":"81","author":"W C Mabie","year":"1993","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"32.e1","DOI":"10.1016\/j.ajog.2014.03.031","article-title":"Maternal mortality in the United States: predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage","volume":"211","author":"S L Clark","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"2160627","DOI":"10.1080\/14767058.2022.2160627","article-title":"Elevated liver enzymes and adverse outcomes among patients with preeclampsia with severe features","volume":"36","author":"K S Greiner","year":"2023","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.metabol.2018.11.014","article-title":"Obesity and nonalcoholic fatty liver disease: from pathophysiology to therapeutics","volume":"92","author":"S A Polyzos","year":"2019","journal-title":"Metabolism"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ajog.2003.08.029","article-title":"Subcapsular liver hematoma in HELLP syndrome: evaluation of diagnostic and therapeutic options\u2013a unicenter study","volume":"190","author":"C Wicke","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"25","key":"ref39","doi-asserted-by":"crossref","first-page":"7942","DOI":"10.1080\/14767058.2021.1939299","article-title":"Hepatic infarction, hematoma, and rupture in HELLP syndrome: support for a vasospastic hypothesis","volume":"35","author":"P A McCormick","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"06","key":"ref40","first-page":"751","article-title":"Preeclampsia associated with hemolysis, elevated liver enzymes, and low platelets\u2013an obstetric emergency?","volume":"62","author":"J MacKenna","year":"1983","journal-title":"Obstet Gynecol"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"S1237","DOI":"10.1016\/j.ajog.2020.09.037","article-title":"Eclampsia in the 21st century","volume":"226","author":"M Fishel Bartal","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref42","doi-asserted-by":"crossref","first-page":"468.e1","DOI":"10.1016\/j.ajog.2013.02.015","article-title":"Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia","volume":"208","author":"J Brewer","year":"2013","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref43","doi-asserted-by":"crossref","first-page":"239.e1","DOI":"10.1016\/j.ajog.2016.02.039","article-title":"Incidence of posterior reversible encephalopathy syndrome in eclamptic and patients with preeclampsia with neurologic symptoms","volume":"215","author":"M Mayama","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref44","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1007\/s00415-016-8377-8","article-title":"Posterior reversible encephalopathy syndrome","volume":"264","author":"M Fischer","year":"2017","journal-title":"J Neurol"},{"issue":"03","key":"ref45","first-page":"1049","article-title":"Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases","volume":"163","author":"B M Sibai","year":"1990","journal-title":"Am J Obstet Gynecol"},{"issue":"07","key":"ref46","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/0002-9378(84)90538-6","article-title":"The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases","volume":"148","author":"J A Pritchard","year":"1984","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref47","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1097\/AOG.0000000000003476","article-title":"Predictive value of signs and symptoms preceding eclampsia: a systematic review","volume":"134","author":"R Hastie","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref48","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1067\/mob.2000.106178","article-title":"Preeclampsia into eclampsia: toward a new paradigm","volume":"182","author":"V L Katz","year":"2000","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref49","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/jog.12697","article-title":"Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia","volume":"41","author":"Y Berhan","year":"2015","journal-title":"J Obstet Gynaecol Res"},{"key":"ref50","volume-title":"Obstetrics, 1st ed","author":"J W Williams","year":"1903"},{"issue":"01","key":"ref51","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1081\/PRG-45776","article-title":"Is high cerebral perfusion pressure and cerebral flow predictive of impending seizures in preeclampsia? A case report","volume":"24","author":"M A Belfort","year":"2005","journal-title":"Hypertens Pregnancy"},{"issue":"08","key":"ref52","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/j.1471-0528.1999.tb08403.x","article-title":"Association of cerebral perfusion pressure with headache in women with pre-eclampsia","volume":"106","author":"M A Belfort","year":"1999","journal-title":"Br J Obstet Gynaecol"},{"key":"ref53","first-page":"1407","article-title":"Antenatal fetal heart rate assessment: where do we go from here?","volume":"132","author":"G J Johnson","year":"2018","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2459-8748.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T23:33:54Z","timestamp":1740440034000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2459-8748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":50,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2459-8748","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,11,4]]},"published":{"date-parts":[[2024,11,4]]}}}