Background: Hypertension in pregnancy is a major health problem responsible for significant maternal and perinatal morbidity and mortality. Early detection and appropriate monitoring may improve outcome. Objective: To determine outcome of hypertensive disorders of pregnancy (HDP) and the associated factors. Method: A prospective study was conducted during June 2015 to March 2016. Target population was Saudi hypertensive and normotensive gravidas attending the Maternity and Children Hospital, Al-Hasaa, Saudi Arabia. Data were collected through a scheduled questionnaire, clinical examination, laboratory investigations, sonographic examinations as well record reviewing. Results: The study included 132 hypertensive and similar normotensive pregnant women matched by age. Pre-eclampsia was the most prevailing subtype (47.7%). HDP increased the risk of maternal (17.4%, RR=5.4) and perinatal (52.3%, RR=4.7) complications. Hypertensive women were more prone to, preterm labour (RR=5.5), Cesarean section (RR=5), labour induction (RR=5), and pregnancy termination (RR=2). Fetal complications included small for gestational age (RR=15.9), intrauterine growth restriction (RR=15.2), prematurity (RR=4.8), and fetal distress (RR=2.2). Neonates were at risk of admission to neonatal intensive care unit (RR=14.2) and low Apgar score at one (RR=14.4) and five minutes (RR=2.2). No deaths were recorded in the study. Pre-eclampsia was the most risky. Incidence of post HDP chronic hypertension was 18.5%. Conclusion: HDP carry a risk for both mothers and babies. Adverse outcome of HDP could be predicted by absent antenatal care, lower maternal age, elevated serum bilirubin, preterm delivery, poor education, uncontrolled blood pressure and primigravida. Proper follow up and timely management may HELLP reduction of unfavourable outcome.