Hypertension is a common medical condition that complicates pregnancy, and has significant adverse effects on pregnancy outcomes, including maternal and perinatal morbidity and mortality. In seeking the aetiology of pregnancy-related hypertension there has been a shift in focus from the foeto-placental axis to the maternal vasculature, and two possibly related pathophysiological mechanisms have been introduced – angiogenesis and apoptosis. Both processes have been extensively studied as possible pathophysiological mechanisms underlying a variety of diseases, including cardiovascular diseases such as hypertension, myocardial infarction, as well as conditions such as malignancy states, and there is a slowly developing body of knowledge justifying hypothesis of roles in pregnancy. This review presents the data regarding this position and explores the role of angiogenesis and apoptosis in the pathogenesis of hypertension in pregnancy and their effects on pregnancy outcomes.