A hypeensive woman has come for preconception counseling. Which of the following antihypeensive is advised to continue once she becomes pregnant?
Women with chronic hypeension are ideally counseled before pregnancy. The duration of hypeension, degree of blood pressure control, and current therapy are asceained. Those women who require multiple medications for control or those who are poorly controlled carry greater risk for adverse pregnancy outcomes. Tell women who take antihypeensive treatments other than ACE inhibitors, ARBs or chlorothiazide that the limited evidence available has not shown an increased risk of congenital malformation with such treatments.Angiotensin-Conveing Enzyme InhibitorsThese drugs inhibit the conversion of angiotensin-I to the potent vasoconstrictor angiotensin-II. They can cause severe fetal malformations when given in the second and third trimesters. These include oligohydramnios, hypocalvaria, and renal dysfunction Some studies also suggest teratogenic effects, and because of this, they are not recommended at any time during pregnancy.Angiotensin - receptor blockers act in a similar manner. But, instead of blocking the production of angiotensin-II, they inhibit binding to its receptor.They are presumed to have the same fetal effects as angiotensin-conveing enzyme inhibitors and thus are also contraindicated.Reference: William's obstetrics; 25th edition; Chapter 50; Chronic Hypeension
Enalapril
Chlohiazide
Nifedipine
Losaan
General obstetrics