Drug of choice for hypertension in pregnancy-

(B) (Methyldopa) (506 Dutta 7th)* Intravenous labetalol or hydralazine are drugs most commonly used to manage preeclampsia (56-H 8th).* Antihypertensive drugs are essential when the BP is 160/110 mm Hg to protect the mother from eclampsia, cerebral hemorrhage, cardiac failure and placental abruption.* First line therapy is either methyldopa or labetalol second line drug is nifedipine. DrugsMechanism of actionSide effectsContraindication and precautionsMethyldopa* Drug of the first choice* Central and peripheral antiadrenergic action* Effective and safe for both the mother and the fetusMaternal - Postural hypotension, hemolytic anemia, sodium retention, excessive sedation, Coomb's test may be positive.Fetal - Intestinal ileusHepatic disorder psychic patients congestive heart failure.Postpartum (risk of depression)HydralazineActs by peripheral vasodilatation as it relaxes the arterial smooth muscle. Orally it is weak and shouldbe combined with methyldopa or b blocker.It increases the cardiac output and renal blood flow* Maternal hypotension, tachycardia arrhythmia, palpitation, lupus-like syndrome, fluid retention.* Fetal - reasonably safe.* Neonatal - ThrombocytopeniaBecause of variable sodium retention diuretics should be used. To control arrhythmias propanol may be administered intravenously.LabetalolCombined a and b adrenergic blocking agents* Tremors, headache asthma, CHF.* Efficacy and safety with short-term use appear equal to methyldopa* Hepatic disorders* Asthma, CHF