Hypertension in pregnancy
BP ≥140/90 mmHg in pregnancy. Classified as chronic (<20 weeks or pre-pregnancy), gestational (>20 weeks without proteinuria), or preeclampsia (>20 weeks with proteinuria or organ involvement). Per ACOG 222 (2020) and SEGO 2023, first-line therapy: methyldopa, labetalol, slow-release nifedipine. BP target: <140/90, <135/85 with organ involvement. ACE inhibitors, ARBs, diltiazem, spironolactone are contraindicated.
ICD-10 O135 drugs
Also known as: Gestational hypertension, Chronic hypertension in pregnancy
Drugs used for this condition
- AHydralazineFirst line · Direct arteriolar vasodilatorHypertensive emergency and preeclampsia. Per ACOG 222 (2020), NICE NG133 2019, SEGO 2023 – IV agent for acute severe BP elevation in pregnancy (≥160/110). Dose 5–10 mg IV slowly, repeated every 20–30 min until BP control (max 30 mg). Alternative – IV labetalol. Not recommended for chronic oral BP control due to tachycardia and lupus-like syndrome.
- ALabetalolFirst line · Alpha- and beta-blockerHypertension in pregnancy and preeclampsia. Per ACOG 222 (2020), NICE NG133 2019, and SEGO 2023, first-line alongside methyldopa and nifedipine. Dose 100–200 mg 2–3 times daily, max 2400 mg/day. For acute severe hypertension/preeclampsia – IV 20 mg bolus, escalating 40–80 mg every 10–20 min up to 300 mg.
- AMethyldopaFirst line · Centrally-acting antiadrenergic agentHypertension in pregnancy. Per ACOG 222 (2020), SEGO 2023, and WHO 2011, first-line with the longest clinical track record. Dose 250–500 mg 2–4 times daily, max 3 g/day. Onset 2–3 h, peak at 6–8 h. No fetal distress, no impact on fetal peripheral resistance.
- ANifedipineFirst line · Dihydropyridine calcium channel blockerHypertension in pregnancy (SR form) and tocolysis in preterm labor (IR off-label). Per ACOG 222 (2020) and SEGO 2023, nifedipine SR is first-line alongside methyldopa and labetalol. SR dose 30–60 mg 1–2 times daily. IR not recommended for HTN due to reflex tachycardia and BP drop.
- CAmlodipineCase-by-case decision · Calcium channel blockers (dihydropyridines)Amlodipine is not a drug of choice in pregnancy: ESH 2023 and the ESC 2025 guideline on cardiovascular disease in pregnancy name labetalol, methyldopa and nifedipine. Under the AEMPS label (section 4.6) it is used only when no safer alternative exists and the disease poses a greater risk to mother and fetus than the drug. Data are limited: a 2022 meta-analysis pooled 17 small randomised trials, mostly from China, found no signal of congenital malformations, but the quality of the studies was low. For a woman whose blood pressure is already controlled on amlodipine, switching to another drug is an individual decision made with her doctor; stopping treatment on her own is not an option, since uncontrolled hypertension is more dangerous.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit