Pharmacologic Options for Treatment and Prevention of Hypertensive Disorders of Pregnancy.

E Nicole Teal, Isabel Katlaps, Jerome Yankowitz

Journal: Clinics in perinatology 2026;53(3):465-480

PMID: 42556973

Abstract

Hypertensive disorders affect 15% of US pregnancies, significantly contributing to maternal and neonatal morbidity. This paper explores the profound hemodynamic adaptations of pregnancy and how their failure leads to conditions like preeclampsia and gestational hypertension. Diagnosis relies on blood pressure thresholds (≥140/90 mm Hg), with management focusing on preventing severe sequelae. Labetalol and nifedipine are established as first-line treatments due to their safety and efficacy, while angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are strictly contraindicated due to fetotoxicity. Low-dose aspirin is recommended for high-risk patients. Ultimately, early recognition and evidence-based pharmacologic intervention are critical for improving obstetric outcomes.

Address: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Diego. Electronic address: [email protected].; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Diego.; Department of Obstetrics and Gynecology, University of Iowa and University of South Florida.

DOI: 10.1016/j.clp.2026.04.002

MeSH Terms: Humans, Pregnancy, Female, Antihypertensive Agents, Hypertension, Pregnancy-Induced, Angiotensin-Converting Enzyme Inhibitors, Nifedipine, Labetalol, Aspirin, Angiotensin Receptor Antagonists, Calcium Channel Blockers, Pre-Eclampsia, Platelet Aggregation Inhibitors