The hypertensive disorders of pregnancy remain major health problems. Blood pressure elevation in pregnancy may be associated with a number of disorders, the most common being preeclampsia-eclampsia, essential hypertension, and chronic parenchymal renal disease. The etiology of preeclampsia-eclampsia continues to be a subject of argument and research. This condition is characterized clinically by hypertension, proteinurea, and edema occurring after the 24th wk of pregnancy and is characterized pathophysiologically by salt and water retention, increased vascular reactivity, and possibly by slow intravascular coagulation. Clinical management continues to be based on rest, sedation, mild salt restriction, osmotic diuresis, and anticonvulsants. Magnesium sulfate or combinations of hydralazine and veratrum alkaloids are used for acute control of blood pressure. Pregnancy is usually well tolerated by patients with mild essential hypertension but can be associated with superimposed preeclampsia-eclampsia, abruptio placentae, and increased fetal mortality in patients with severe hypertension. Standard antihypertensive agents are used to manage blood pressure in such patients with the exceptions of reserpine, which causes increased fetal respiratory tract secretions, and guanethidine, which causes marked postural hypotension in the pregnant subject. A subgroup of patients have been identified who develop blood pressure elevation in late pregnancy that remits within 10 days after delivery. Persistence of hypertension beyond this period calls for evaluation of secondary causes of hypertension and appropriate therapy.