From the Guidelines
Labetalol is the preferred first-line treatment for chronic hypertension in pregnancy during the first trimester, though nifedipine (Procardia) is also an acceptable option. The most recent and highest quality study, published in 2025, recommends the use of labetalol and nifedipine as first-line antihypertensive agents during pregnancy 1. For labetalol, a typical starting dosage is 100-200 mg orally twice daily, which can be titrated up to 800 mg twice daily as needed. Labetalol is favored because it has a long safety record in pregnancy, minimal placental transfer, and effectively lowers blood pressure without significantly reducing uteroplacental blood flow. It also has both alpha and beta-blocking properties, providing balanced blood pressure control. Nifedipine (extended-release formulation, starting at 30-60 mg daily) is a reasonable alternative, particularly for women with asthma or other contraindications to beta-blockers.
Key Considerations
- Blood pressure targets should be 140-150/90-100 mmHg to balance maternal risk reduction while maintaining adequate placental perfusion 1.
- Regular monitoring of blood pressure, maternal symptoms, and fetal growth is essential throughout pregnancy.
- Treatment should be individualized based on comorbidities, prior medication response, and side effect profiles.
- The use of ACE inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors is contraindicated in pregnancy due to their associations with fetal teratogenicity and oligohydramnios 1.
Alternative Options
- Methyldopa is another consideration for first-line therapy for hypertension in pregnancy, and is the only medication with long-term information on infant outcomes 1.
- Clonidine transdermal patch preparations can be invaluable in pregnant individuals with hyperemesis who require BP lowering 1.
- Atenolol should not be used due to risk of fetal growth restriction 1.
The American College of Cardiology/American Heart Association guideline also recommends the use of labetalol, nifedipine, and methyldopa for the treatment of hypertension in pregnancy 1. Additionally, the International Society for the Study of Hypertension in Pregnancy recommends the use of labetalol, nifedipine, and methyldopa as first-line antihypertensive agents during pregnancy 1. However, the most recent and highest quality study, published in 2025, should be prioritized when making treatment decisions 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Chronic Hypertension in Pregnancy
The treatment of chronic hypertension in pregnancy is crucial to prevent adverse maternal and fetal outcomes. Two commonly used medications for this condition are labetalol and nifedipine.
Comparison of Labetalol and Nifedipine
- Labetalol is a beta-blocker that is often used as a first-line treatment for hypertension in pregnancy 2, 3.
- Nifedipine, a calcium channel blocker, is also a valid option for treating mild to moderate hypertension in pregnancy 4, 3, 5.
- A systematic review and meta-analysis found that nifedipine may be preferred as the first-line agent for severe hypertension in pregnancy, with a lower risk of persistent hypertension compared to labetalol and hydralazine 4.
- Another study found that nifedipine was superior to hydralazine but not labetalol for successful treatment of severe hypertension in pregnancy 5.
Safety and Efficacy
- Both labetalol and nifedipine are considered safe for use in pregnancy, but the evidence is limited, and more studies are needed to establish their long-term effects on the mother and fetus 3, 6.
- Nifedipine has been shown to provide maternal benefit by lowering blood pressure and reducing the risk of cerebral hemorrhage and end-organ damage, but its perinatal benefit remains to be established 6.
Current Guidelines and Recommendations
- Current guidelines recommend labetalol, nifedipine, and methyldopa as acceptable first-line agents to treat hypertensive disorders of pregnancy in outpatient settings 2.
- The choice of medication should be individualized based on the patient's specific needs and medical history, and close monitoring of blood pressure and fetal well-being is essential 3, 5.