The development of a logical and physiologically sound approach to the management of gestational hypertension presents a formidable challenge to both obstetrician and internist. The maternal and fetal risks and sequelae are well known and significant. Therefore, understanding the pathophysiology of the particular hypertensive syndrome or disease being treated is of great importance if a rational approach to treatment is to be accomplished. In this discussion we will present the pharmacology of the various antihypertensive agents currently being used, followed by a brief discussion of our current concept of the pathophysiology of the three major types of hypertension seen during pregnancy and finally by our suggested management.