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Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations

Al Khaja, Khalid A.J.a; Sequeira, Reginald P.a; Alkhaja, Alwaleed K.b; Damanhori, Awatif H.H.c

doi: 10.1097/HJH.0000000000000069

This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines’ utility and credibility in clinical practice.

aDepartment of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain

bQatar Foundation, Doha, Qatar

cPrimary Care, Ministry of Health, Manama, Kingdom of Bahrain

Correspondence to Professor Khalid A.J. Al Khaja, PhD, Department of Pharmacology & Therapeutics, Arabian Gulf University, PO Box 22979, Manama, Kingdom of Bahrain. Tel: +973 39644642; fax: +973 17271090; e-mail:

Abbreviations: ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; CCBs, calcium channel blockers

Received 9 April, 2013

Revised 6 November, 2013

Accepted 6 November, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins