(Abstracted from N Engl J Med 2022;386:1781–1792)Chronic hypertension develops in 2% of pregnancies in the United States. As this condition disproportionately affects Black women and is associated with 3 to 5 times the risk of placental abruption, preeclampsia, preterm birth (PTB), small-for-gestational-age (SGA) birthweight, and perinatal death, optimizing treatment is critical to possibly preventing these associated complications.