What are the recommended antihypertensive medications for pregnant women with hypertension?

From the Guidelines

For pregnant women with hypertension, labetalol, nifedipine, and methyldopa are the preferred medications, as they are considered safe during pregnancy and help reduce maternal and fetal complications 1.

Key Considerations

• Labetalol is typically started at 100-200mg twice daily and can be increased as needed up to 800mg daily.
• Nifedipine (extended-release) usually begins at 30mg daily, with a maximum of 120mg daily.
• Methyldopa starts at 250mg twice daily and can be titrated up to 2g daily.

Important Safety Information

• ACE inhibitors and ARBs should be avoided as they can cause fetal harm 1.
• Blood pressure should be maintained below 150/100 mmHg, but not lowered too aggressively (avoid below 120/80 mmHg) to ensure adequate placental perfusion.

Monitoring and Postpartum Care

• Regular monitoring is essential, with blood pressure checks, urine protein assessment, and fetal growth evaluation.
• Treatment should continue postpartum, with medication adjustments as needed since some hypertension resolves after delivery while others may persist or develop into chronic hypertension.

Recent Guidelines

• The 2020 European Society of Cardiology position paper on peripartum management of hypertension suggests labetalol and nifedipine as first-line treatment for hypertensive emergencies during pregnancy 1.
• Methyldopa is not recommended for urgent blood pressure reduction, and magnesium sulfate should not be given concomitantly with calcium channel blockers due to the risk of hypotension 1.

From the FDA Drug Label

Pregnancy Teratogenic Effects. Reproduction studies performed with methyldopa at oral doses up to 1000 mg/kg in mice, 200 mg/kg in rabbits and 100 mg/kg in rats revealed no evidence of harm to the fetus. Published reports of the use of methyldopa during all trimesters indicate that if this drug is used during pregnancy the possibility of fetal harm appears remote. In five studies, three of which were controlled, involving 332 pregnant hypertensive women, treatment with methyldopa was associated with an improved fetal outcome

Methyldopa can be used as a hypertension medication in pregnancy.

• It has been shown to have no evidence of harm to the fetus in animal studies.
• Published reports indicate that the possibility of fetal harm appears remote.
• Studies have shown an improved fetal outcome when used in pregnant hypertensive women. 2

From the Research

Hypertension Medication for Pregnancy

• Hypertension is a common medical disorder in pregnancy, complicating one in ten pregnancies 3.
• The treatment of severely increased blood pressure is widely recommended to reduce the risk for maternal complications 3, 4.
• Oral antihypertensive regimens, such as nifedipine retard, labetalol, and methyldopa, are viable options for managing severe hypertension in pregnancy 3, 5, 6, 7.

Oral Antihypertensive Agents

• Nifedipine, labetalol, and methyldopa are the most commonly used oral antihypertensive agents for treating severe hypertension in pregnancy 3, 5, 6, 7.
• Nifedipine has been shown to be effective in reducing blood pressure and achieving treatment success in most women 3, 5, 6, 7.
• Labetalol and methyldopa are also effective, but may have a lower success rate compared to nifedipine 3, 5, 6.

Safety and Efficacy

• The safety and efficacy of oral antihypertensive agents have been evaluated in several studies, with no significant differences in maternal and fetal outcomes found between the different agents 3, 5, 6, 7.
• Nifedipine may be preferred as the first-line agent due to its effectiveness and safety profile 6, 7.
• The choice of antihypertensive agent should be based on individual patient needs and medical history 4.