Hypertensive disorders in pregnancy (HDP) are significant challenges in obstetrics, with a prevalence of 7.8% in India, including 5.4% pre-eclampsia. These disorders affect multiple systems, including cardiovascular, respiratory, neurological, renal, hematologic, hepatic, and uteroplacental. Management aims to ensure the safe delivery of a healthy infant or terminate the pregnancy with minimal trauma. Key conditions include pre-eclampsia, eclampsia, and HELLP syndrome. Diagnosis involves blood pressure and proteinuria criteria, with severity graded based on clinical findings. Treatment includes antihypertensive drugs like labetalol, hydralazine, and nifedipine, magnesium sulfate for seizure prevention, and careful monitoring. Anaesthetic management is crucial, considering the systemic effects on various organs. Regional anaesthesia is preferred in many cases, with careful pre-anaesthetic assessment and optimization of physiology. HELLP syndrome, a severe form of pre-eclampsia, requires immediate intervention to stabilize the mother and fetus. Low-dose aspirin is used for prevention, and fluid management is essential to avoid complications. Overall, a multidisciplinary approach is necessary to manage HDP effectively.Hypertensive disorders in pregnancy (HDP) are significant challenges in obstetrics, with a prevalence of 7.8% in India, including 5.4% pre-eclampsia. These disorders affect multiple systems, including cardiovascular, respiratory, neurological, renal, hematologic, hepatic, and uteroplacental. Management aims to ensure the safe delivery of a healthy infant or terminate the pregnancy with minimal trauma. Key conditions include pre-eclampsia, eclampsia, and HELLP syndrome. Diagnosis involves blood pressure and proteinuria criteria, with severity graded based on clinical findings. Treatment includes antihypertensive drugs like labetalol, hydralazine, and nifedipine, magnesium sulfate for seizure prevention, and careful monitoring. Anaesthetic management is crucial, considering the systemic effects on various organs. Regional anaesthesia is preferred in many cases, with careful pre-anaesthetic assessment and optimization of physiology. HELLP syndrome, a severe form of pre-eclampsia, requires immediate intervention to stabilize the mother and fetus. Low-dose aspirin is used for prevention, and fluid management is essential to avoid complications. Overall, a multidisciplinary approach is necessary to manage HDP effectively.