Pregnancy may be complicated by hypertension either as a pre-existing condition or as a newly diagnosed condition during pregnancy. Each condition carries with it significant risks and important management considerations that may impact the well-being of both the mother and fetus. Pre-eclampsia, a multisystem disorder that is marked by pregnancy-induced hypertension and evidence of end-organ involvement, is a significant obstetrical risk that affects approximately 5% of pregnancies. Evidence of end-organ involvement may include proteinuria, thrombocytopenia, visual complaints, pulmonary edema, or impaired hepatic function. Proteinuria has traditionally been considered the hallmark of pre-eclampsia but is not necessary for the diagnosis.