From the Guidelines
For a pregnant woman currently taking lisinopril, the medication should be discontinued immediately and switched to methyldopa, nifedipine, and/or labetalol as these are recommended alternatives for blood pressure management during pregnancy. The decision to discontinue lisinopril is based on the strong recommendation against the use of ACE inhibitors, ARBs, or direct renin inhibitors in pregnant women due to potential harm to the fetus 1. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, women with hypertension who become pregnant should be transitioned to methyldopa, nifedipine, and/or labetalol during pregnancy 1.
Key considerations for the management of hypertension in pregnancy include:
- Discontinuing ACE inhibitors like lisinopril due to their association with fetal harm 1
- Initiating methyldopa, nifedipine, and/or labetalol as safe alternatives for blood pressure control 1
- Close monitoring of blood pressure during the transition to ensure adequate control
- Regular prenatal visits to assess both maternal and fetal health throughout the pregnancy
The goal of antihypertensive treatment during pregnancy is to prevent severe hypertension and potentially prolong gestation, allowing the fetus more time to mature before delivery 1. It is crucial for the patient to contact her healthcare provider without delay to switch medications and ensure a safe and healthy pregnancy outcome.
From the Research
Alternatives to Lisinopril for Pregnant Women
- Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, which is generally not recommended during pregnancy due to potential fetal risks 2, 3.
- For a pregnant woman who was previously taking lisinopril, alternative antihypertensive medications may be considered.
- Options may include:
- Methyldopa: a centrally acting alpha-2 adrenergic agonist that has been used for decades to treat hypertension in pregnancy 2, 3, 4.
- Labetalol: a mixed alpha- and beta-blocker that is commonly used to manage hypertension in pregnant women 2, 3, 4.
- Nifedipine: a calcium channel blocker that can be used to treat severe hypertension in pregnancy 2, 3.
Considerations for Antihypertensive Medication Use in Pregnancy
- The choice of antihypertensive medication during pregnancy should be individualized based on the woman's specific needs and medical history 2, 3.
- It is essential to monitor blood pressure and adjust medication as needed to minimize risks to the mother and fetus 2, 3.
- The studies suggest that methyldopa, labetalol, and nifedipine are viable options for treating hypertension in pregnancy, but more research is needed to fully understand their pharmacokinetics and effects on the fetus 3.
Pharmacokinetics and Pharmacodynamics of Antihypertensive Medications in Pregnancy
- The pharmacokinetics of methyldopa, labetalol, and nifedipine during pregnancy are not well understood, and more studies are needed to determine their optimal dosing and potential effects on the fetus 3.
- The interaction between trophoblasts and maternal endothelium is crucial for placental vascular modeling, and some antihypertensive medications may affect this process 4.