The objective of this study is to investigate differences in maternal and fetal outcomes among pregnant patients with chronic hypertension requiring antihypertensives for adequate control versus those who do not require antihypertensives. Single-site retrospective cohort study including pregnant patients with chronic hypertension from December 2012 - December 2018. Patients were divided into two groups, those who required antihypertensives versus those who did not. The primary outcome was composite maternal morbidity which included: pregnancy loss after 20 weeks, IUGR, maternal death, maternal stroke or TIA, pulmonary edema, renal failure, hypertensive emergency, HELLP syndrome, placental abruption or delivery before 34 weeks. Secondary outcomes included neonatal outcomes and the occurrence of severe range blood pressures during pregnancy. Student t, chi square, and Kruskal-Wallis tests were used where appropriate. Adjusted odds ratios were calculated using logistic regression to account for potential confounders. Our study cohort included 117 patients in the antihypertensive group and 114 in the no antihypertensive group. Requiring antihypertensives for blood pressure control was associated with the composite primary outcome (Odds ratio [OR], 3.88; 95% confidence interval [CI], 1.66- 9.78). All individual outcomes included in the composite outcome were more common in the antihypertensive group including IUGR (OR 2.85, 95% CI: 1.01-9.21) and delivery less than 34 weeks (OR 7.17 95% CI: 2.01-38.7). Logistic regression analysis found that the association persisted even after adjustment for age, BMI, and presence of gestational diabetes. Current recommendations for treating hypertension in pregnancy with medications divide hypertensive patients into two unique groups. In our study, those who require antihypertensives during pregnancy more often experienced adverse outcomes than patients who did not. Future studies should focus on whether treatment/surveillance of patients on antihypertensives should differ from those who are not on antihypertensives.