Table 2: Recommended treatment of nonsevere hypertension in pregnancy

Treatment goal DBP 80-90 mm Hg (grade D)

First-line drug Methyldopa (grade A)9,25

Second-line drugs* Labetalol (grade A/B)12,14,26-28 Pindolol (grade A/B)29 Oxprenolol (grade A/B)17,18,28 Nifedipine (grade A/B)15,30

Third-line drugs Clonidine + hydralazine (grade A, but monotherapy preferable)13 Metoprolol + hydralazine (grade A, but monotherapy preferable)11 Clonidine (grade B)31 Methyldopa + a second-line drug or hydralazine (grade D)

Special indications (renal or cardiac diseases) Diuretics (grade D)

Drugs to avoid Angiotensin-converting enzyme inhibitors (grade C)32-35 Angiotensin II receptor antagonists (grade D)

Caution Neuromuscular function and blood pressure should be closely monitored when using nifedipine + magnesium sulfate (grade D) Fetuses and newborns of women taking atenolol, acebutolol or metoprolol should be observed for signs of ß-blockage (grade D)

*For second-line drugs, recommendations are grade A for the prevention of severe hypertension and grade B for the prevention of perinatal death.

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