Preeclampsia (PE) is one of the leading cause of adverse maternal and perinatal outcomes. Antihypertensive treatment aims to reduce serious maternal complications such as maternal stroke, heart failure, pulmonary edema, renal injury, and eclampsia, while avoiding an excessively rapid decline in blood pressure that may compromise uteroplacental perfusion. This review addresses the therapeutic targets, timing of initiation, blood pressure goals and commonly used antihypertensive agents in the management of PE, and also discusses the management of acute severe hypertension, special clinical scenarios, and major controversies, emphasizing the importance of continuous, stable, and individualized blood pressure management.