Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension, severe diastolic hypertension, or both, require urgent antihypertensive therapy. The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion on this topic, offering both recommendations and conclusions, including:

• Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes.

• Close maternal and fetal monitoring by a physician and nursing staff are advised during the treatment of acute-onset, severe hypertension.
• After initial stabilization, the team should monitor blood pressure closely and institute maintenance therapy as needed.
• Intravenous (IV) labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period.
• Immediate release oral nifedipine also may be considered as a first-line therapy, particularly when IV access is not available.
• The use of IV labetalol, IV hydralazine, or immediate release oral nifedipine for the treatment of acute-onset, severe hypertension for pregnant or postpartum patients does not require cardiac monitoring.