Purpose of Review <p>This review aims to highlight recent updates on the management of chronic hypertension in pregnancy. It will attempt to provide an overview of the findings from emerging randomized clinical trials, systematic reviews and meta-analyses as well as updates in recommendations from international guidelines. Key focus areas include evolving definitions and thresholds, treatment targets, antihypertensive selection, delivery timing, and the role of aspirin prophylaxis.</p> Recent Findings <p>Recent data support lowering the diagnostic and treatment thresholds for chronic hypertension in pregnancy, with emerging evidence suggesting that tighter blood pressure control may improve outcomes without increasing the risk of fetal growth restriction. Labetalol and nifedipine remain first-line agents, though recent data has provided insights into comparative efficacy and risk profiles. Optimal timing for delivery remains under investigation, the 37-to-39-week gestational window seems to offer a favorable risk-to-benefit ratio but the exact timing within this window is not clear. The benefit of low-dose aspirin for preeclampsia prevention in this population is less consistent than in other high-risk groups, with recent analyses suggesting limited efficacy in individuals with chronic hypertension.</p> Summary <p>Current evidence supports initiating antihypertensive treatment at or above 140/90 mmHg, with emerging data suggesting that lower targets may be beneficial. Aspirin remains recommended for preeclampsia prevention, although its benefit in chronic hypertension may be modest. Delivery planning should be individualized, with most guidelines supporting delivery between 37 and 39 weeks. Ongoing trials will help refine these recommendations, but individualized care based on evolving evidence remains key.</p>