This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

Hypertension in pregnancy (antihypertensive treatment)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

NICE have stated that (1):

  • in pregnancy labetalol is the first line treatment
    • only offer women with gestational hypertension antihypertensive treatment other than labetalol after considering side-effect profiles for the woman, fetus and newborn baby. Alternatives include methyldopa and nifedipine

General principles about use of antihypertensive medication in pregnancy:

  • advise women who take antihypertensive treatments other than ACE inhibitors, ARBs, thiazide or thiazide-like diuretics that the limited evidence available has not shown an increased risk of congenital malformation with such treatment (1)

  • labetolol (alpha and beta-blocker) is a commonly first line agent in hypertension in pregnancy - especially for resistant hypertension in the third trimester - other beta-blockers are less often used, especially before 28 weeks gestation, because of concerns that their use may lead to an inhibition of fetal growth

  • methyl dopa is a centrally acting antihypertensive which is used as a second line agent for idiopathic hypertension or pre-eclampsia

  • the calcium antagonist nifedipine is suggested as an alternative as a second-line drug for hypertension in pregnancy
    • the vasodilator drug hydralazine is sometimes used in pregnancy (seek expert advice)

  • diuretics are not generally used in the management of hypertension in pregnancy - this is because diuretics have the theoretical potential to further reduce the circulatory volume in women with pre-eclampsia
    • NICE state that chlorothiazide diuretics (1):
      • may be an increased risk of congenital abnormality and neonatal complications if these drugs are taken during pregnancy
      • a woman should discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy

  • ACE inhibitors are contra-indicated in pregnancy - they may cause oligohydramnios, hypotension, renal failure, and intra-uterine death in the fetus; ACE inhibitors (and Angiotensin Receptor Blockers) should be avoided by women who wish to become pregnant
    • NICE suggest that clinicians should advise women who take angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs):
      • that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy
      • alternative antihypertensive treatment should be discussed with the healthcare professional responsible for managing their hypertension, if a woman is planning pregnancy and taking an ACEI/ARB
      • alternative treatment should be discussed with the healthcare professional responsible for managing their condition, if ACE inhibitors or ARBs are being taken for other conditions such as renal disease
      • stop antihypertensive treatment in women taking ACE inhibitors or ARBs if they become pregnant (preferably within 2 working days of notification of pregnancy) and offer alternatives

  • continue with existing antihypertensive treatment if safe in pregnancy, or switch to an alternative treatment, unless:
    • sustained systolic blood pressure is less than 110mmHg or
    • sustained diastolic blood pressure is less than 70mmHg or
    • the woman has symptomatic hypotension

  • offer antihypertensive treatment to pregnant women who have chronic hypertension and who are not already on treatment if they have:
    • sustained systolic blood pressure of 140mmHg or higher or
    • sustained diastolic blood pressure of 90mmHg or higher

  • when using medicines to treat hypertension in pregnancy, aim for a target blood pressure of 135/85mmHg

  • consider labetalol to treat chronic hypertension in pregnant women
    • consider nifedipine for women in whom labetalol is not suitable, or methyldopa if both labetalol and nifedipine are not suitable
      • base the choice on any pre-existing treatment, side-effect profiles, risks (including fetal effects) and the woman's preference

  • offer pregnant women with chronic hypertension aspirin75-150 mg once daily from 12 weeks

  • offer placental growth factor (PlGF)-based testing to help rule out preeclampsia between 20 weeks and up to 35 weeks of pregnancy, if women with chronic hypertension are suspected of developing pre-eclampsia. (See the NICE diagnostics guidance on PlGF-based testing to help diagnose suspected preeclampsia)

The role of hypertension in maternal pathology remains uncertain. There is little evidence to indicate that seizures in pre-eclampsia are caused by hypertension or will be prevented by anti-hypertensive treatment. The control of hypertension serves as a useful expedient whilst awaiting definitive treatment - ie. delivery of the placenta.

Reference:

  1. NICE (June 2019). Hypertension in pregnancy - the management of hypertensive disorders during pregnancy

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.