Management of Hypertension in Pregnancy

Introduction to Hypertension Management

• The American College of Cardiology recommends that ACE inhibitors, ARBs, and spironolactone be discontinued immediately upon pregnancy planning or confirmation due to severe fetotoxicity 1, 2, 3

Safe Alternative Medications

• The American Heart Association recommends labetalol IV as a first-line alternative for acute/severe hypertension in pregnancy, with a dosage of 20 mg initial bolus, then 40 mg after 10 minutes, then 80 mg every 10 minutes (maximum 220 mg) 6
• The American College of Obstetricians and Gynecologists recommends methyldopa as a safe alternative for chronic hypertension management, with a dosage of 250-500 mg twice daily 7, 6, 5

Blood Pressure Targets During Pregnancy

• The American College of Cardiology recommends a target blood pressure of 110-135/85 mmHg during pregnancy to reduce maternal hypertensive complications while minimizing fetal growth impairment 1, 2, 5

Clinical Management Algorithm

• The European Society of Cardiology recommends that women currently taking ACE inhibitors/ARBs/spironolactone switch to methyldopa, labetalol, or long-acting nifedipine immediately if planning pregnancy 5
• The American Heart Association recommends discontinuing ACE-I/ARB/spironolactone the same day and substituting a safe alternative if pregnancy is confirmed 1, 2