Table 4: Drugs Used for the Management of Hypertension During Pregnancy
| Drug Class | Example | Pregnancy Risk Category | Comment |
|---|---|---|---|
Central ΰ-agonist |
(Aldomet®) |
C |
Drug of choice by the NHBPEP* Working Group |
α-Blockers |
Atenolol (Tenormin®) Metoprolol (Lopressor®) Labetolol(ΰ)®) | C C C |
Calcium antagonists |
Diltiazem (Cardizem® CD, Dilacor® XR, Trizac® Verapamil (Calan®, Covera-HS®, Verelan®) | C
C |
Potential synergism with magnesium sulfate may lead to precipitous hypotension |
ACE inhibitors |
Captopril (Capoten®) |
D |
Fetal abnormalities including death, can be caused, and should not be used in pregnancy |
Angiotensin IIReceptor blockers |
Enalapril (Vasotec®) Lisinopril (Prinivil, Zestril®) Losarten (Cozaar®) Valsarten (Diovan®)
|
D D D D |
Diuretics |
Bumetanide (Bumex®) Frosemide (Lasix®) Hydrochlorothiazide (HydroDIURIL®) Indapamide (Lozol®) Spironolactone (Aldactone®) Triamterine (Dyrenium®) | DCCBBDB |
Recommended for chronic hypertension if prescribed before gestation or if patients are salt-sensitive. Not recommended in preclampsia |
Directvasodilators |
Hydralazine (Apresoline®) Minoxidil (Loniten®) |
C C |
Hydralazine is parenteral drug of choice vased on its long history of safety and efficacy |
* NHBPEP: National High Blood Pressure Education Program Adapted from: The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the joint national committee on prevention, detection, evaluation, and treatmenrt of high blood pressure. Arch Intern Med 1997; 157: 2413-46. |