Severe hypertension in pregnancy is categorized with the same criteria as for stage 2 hypertension in nonpregnant adults according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (BP 160/110 mmHg) and is associated with high risk for stroke and eclampsia.131,161 The American College of Obstetricians and Gynecologists recommends treatment of severe hypertension and suggests labetalol as first-line therapy,121 and it recommends avoidance of atenolol, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers. In addition to pharmacological control of hypertension, the use of magnesium sulfate for seizure prophylaxis is well established and has been demonstrated in randomized trials to decrease risk of stroke in women with severe high BP in pregnancy and eclampsia. A Cochrane review showed a >50% reduction in eclampsia with the use of magnesium sulfate ver- 0.58; number needed to treat for additional benefit, 100), with a nonsignificant decrease in maternal death (RR, 0.54; 95% Although modest decrements in BP can be observed with magnesium sulfate alone, the latter has not been shown to effectively decrease BP in moderate to severe high BP in pregnancy, and there is no evidence to support its use as monotherapy.125 Pregnancy Complications and the Long-term Risk of Stroke An expanding body of research has shown that complica- tions of pregnancy (preeclampsia, gestational diabetes, and pregnancy-induced hypertension) are associated with higher risk for future CVD and stroke beyond the childbearing years than among women without these disorders163 (Tables 5 and 6). For example, women with a history of preeclampsia have a markedly increased risk for developing renal disease and a 2- to 10-fold increase in risk for development of chronic hypertension, a major risk factor for stroke. 