How should I approach the management of a pregnant patient with pre-existing hypertension who is planning to conceive?

All women with chronic hypertension planning to conceive should undergo accurate diagnostic and functional evaluation prior to pregnancy to predict maternal and fetal risk ².

Women with pulmonary hypertension, an aortic aneurysm, severe aortic stenosis, or symptomatic ventricular dysfunction should be advised against becoming pregnant and should continue contraception until assessment by a cardiologist ².

Women with a history of hypertension should be referred to a specialist in hypertensive disorders before pregnancy to discuss risks and management options ².

Advise women to continue using effective contraception until fully assessed and to not stop their current medication unless directed by a specialist ².

Discuss pre-conception measures such as weight management, exercise, healthy eating, and reducing salt intake ³.

Avoid ACE inhibitors and angiotensin II receptor blockers in women planning pregnancy due to increased risk of congenital abnormalities; discuss alternative antihypertensive treatments with a healthcare professional ³.

Consider the use of aspirin 75-150 mg daily from 12 weeks gestation if pregnancy proceeds, after appropriate assessment ³.