Hypertension in pregnancy contributes significantly to both maternal and neonatal morbidity and mortality. Among different forms of pregnancy-associated hypertension, preeclampsia-eclampsia has the highest impact on morbidity and mortality. Chronic hypertension may result in preterm and small for gestational age infants, even when it is mild-to-moderate. Chronic hypertension is a risk factor for superimposed preeclampsia and results in higher rates of adverse outcome. Preeclampsia is a multisystemic disease that is thought to be initiated by abnormalities in placental perfusion and endothelial dysfunction, ultimately resulting in multiorgan failure. Preeclampsia is more common in women of minority ethnicity who are socioeconomically disadvantaged. Pharmacologic therapy for hypertensive disorders in pregnancy is limited by concerns regarding the safety of both mother and fetus. Although treatment of severe hypertension is not debated, there is no consensus on the rationale for pharmacologic therapy of mild-to-moderate hypertension in pregnancy.