Treatment of Elevated BP During Pregnancy, Including Preeclampsia The central autoregulatory plateau in pregnancy is estimated at 120 mmHg, and women with moderate to severe high BP in pregnancy, especially those with preeclampsia, are at risk for loss of central cerebral vascular autoregulation. The association between high BP and stroke risk in women with preeclampsia is not linear, such that stroke can occur at moderately elevated BPs, which suggests that current thresholds for treatment may not be sufficiently stringent.159 Pharmacological treatment to lower BP during pregnancy should be chosen after consideration of tolerability, preex- isting therapy, and risk of teratogenicity, because all agents cross the placenta. (Table 4). High BP during pregnancy may be defined as mild (dia- stolic BP 90 99 mmHg or systolic BP 140 149 mmHg), moderate (diastolic BP 100 109 mmHg or systolic BP 150 159 mmHg), or severe (diastolic BP 110 mmHg or systolic BP 160 mmHg). The goal of BP management in pregnancy is to maintain systolic BP between 130 and 155 mmHg and diastolic BP between 80 and 105 mmHg, with lower target ranges in the context of comorbidity; however, the treatment rationale for women with mild to moderate high BP in preg- nancy is not as clear-cut as for severe high BP in pregnancy because maternal and fetal risk-benefit ratios have not been For example, a meta-analysis that examined the association between reduction in maternal BP and fetal growth found that a 10-mmHg decrement in maternal mean arterial pressure was associated with a 176-g decrease in neo- natal birth weight, regardless of the antihypertensive agent In addition, Abalos et al132 performed a meta-analysis of randomized controlled trials of treatment versus no treat- ment of mild to moderate high BP in pregnancy. 