Drug of Choice in Gestational Hypertension

Initial Assessment and Treatment Thresholds

The European Society of Cardiology recommends non-pharmacological management for pregnant women with mild hypertension (SBP 140-149 mmHg or DBP 90-99 mmHg) 2, 3
Antihypertensive therapy should be initiated when BP ≥140/90 mmHg in women with gestational hypertension, pre-existing hypertension with superimposed gestational hypertension, or hypertension with subclinical organ damage 2, 4
The American College of Obstetricians and Gynecologists recommends initiating antihypertensive therapy when BP ≥150/95 mmHg in all other pregnant women 2, 5

Methyldopa (750 mg to 4 g per day in 3-4 divided doses) is the preferred first-line agent due to its safety record and no evidence of adverse effects in mothers or babies 1
The European Society of Cardiology identifies methyldopa as the drug of choice in pregnancy due to its established safety record and extensive clinical experience 1

Severe hypertension (SBP ≥170 mmHg or DBP ≥110 mmHg) requires immediate hospitalization 2, 4
Treatment options for severe hypertension include oral nifedipine 2, 6
IV hydralazine should be avoided due to association with more perinatal adverse effects 3, 6

Diuretics should only be used in combination with other drugs, particularly when vasodilators exacerbate fluid retention 1
Methyldopa should be avoided post-partum due to risk of post-natal depression 2, 5
Atenolol should be used with caution due to potential association with fetal growth restriction 3

Women who develop gestational hypertension are at increased risk of hypertension and cardiovascular disease later in life 2, 7
Women experiencing hypertension in their first pregnancy are at increased risk in subsequent pregnancies 2, 5