Antihypertensive drugs to treat hypertension in pregnancy
What antihypertensive drugs can be used to treat hypertension in pregnancy?
Use of angiotensin converting enzyme inhibitor (ACEi) in the second and third trimester is associated with renal dysplasia, oligohydramnios, and neonatal death from hypoplastic lungs. Using ACEis in the first trimester may cause cardiac anomalies in the neonate.
There are less data on angiotensin receptor blockers (ARBs), but they are avoided because of concern that their effects will be similar to those of ACEis. Direct renin inhibitors, such as aliskiren, should also be avoided.
Alpha methyldopa has been used for more than 50 years to treat hypertension in pregnant women and careful follow-up on children support its safety. Labetalol, hydralazine, and calcium channel blockers are safe. Calcium channel blockers may cause severe hypotension when used with magnesium. Hydralazine is ineffective as a single oral agent, but may be effective when used with a sympatholytic drug. Beta blockers, particularly atenolol, have been reported to have adverse effects on fetal growth and labetalol can usually be used as an alternative.
They are not considered contraindicated. Diuretics have been associated with less than normal expansion of plasma volume but may be necessary in women with underlying kidney disease. Intravenous hydralazine and labetalol are the drugs most commonly used for hypertensive emergencies.
