title: Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations.
abstract: 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.
authors.affiliation: 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.
authors.forename: Khalid A J
authors.initials: KA
authors.lastname: Al Khaja
authors.forename: Reginald P
authors.initials: RP
authors.lastname: Sequeira
authors.forename: Alwaleed K
authors.initials: AK
authors.lastname: Alkhaja
authors.forename: Awatif H H
authors.initials: AH
authors.lastname: Damanhori
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D000075202:Contraindications; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D008750:Methyldopa / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D008750:Methyldopa