Managing high blood pressure in pregnancy – an analysis of antihypertensive drugs

This study investigated the safety and effectiveness of anti-hypertensive (AHT) drugs in pregnancy. 

They found that AHTs were generally safe in pregnancy.

Hypertension or high blood pressure (BP) is present in 3-5% of pregnancies. Uncontrolled BP can have negative effects on the mother and baby. Hypertension is linked to a number of conditions. The most serious of these is preeclampsia (PE). PE can be life-threatening for mother and baby. Some neonatal outcomes linked to hypertension include pre-term birth (PTB) and cesarian delivery (CD). Maternal outcomes include PE, kidney injury or stroke. 

High BP can be reduced using anti-hypertensive (AHT) drugs. There are several AHTs that are considered safe in pregnancy. These include methyldopa, calcium channel blockers (CCBs), beta-blockers (BBs) and diuretics. Each of these AHT types work in specific ways to reduce BP. There are no clear guidelines on the optimal AHT to use in pregnancy. It is unclear if certain AHTs are more suitable in pregnancy. 

This study included 22 clinical studies on AHT use in pregnancy. 4,464 women took part in these studies. The main outcomes were PE and small-for-gestational-age (SGA). Other outcomes included CD and PTB. 

8 different AHTs were used in patients to prevent PEP. None of the AHTs reduced the risk of PE. Furosemide (Lasix) had the highest risk for side effects. Atenolol (Tenormin) was associated with a higher risk of SGA.

The risk of severe hypertension was reduced by nifedipine (Adalat) and methyldopa (Aldomet). Ketanserin (Sufrexal) and pindolol (Visken) also reduced the risk of severe hypertension. The risk of placental abruption was lowest with nifedipine and methyldopa. Placental abruption is when the placenta (is connected to the womb wall and supplies blood and nutrients to the baby) separates from the womb. There were no significant differences in CD or PTB risk with different AHTs. 

The authors concluded that AHTs were generally safe in pregnancy.

If you have any concerns regarding hypertension during pregnancy please consult with your physician.