A 28-year-old primigravida at 32 weeks of gestation presents with blood pressure 158/102 mmHg, proteinuria 2+ on dipstick, and hyperreflexia. She has no symptoms of imminent eclampsia. What is the drug of choice for antihypertensive therapy in this patient?

Question

Accepted Answer

B. Labetalol. ## First-Line Antihypertensive in Pregnancy-Induced Hypertension

**Key Point:** Labetalol is the first-line oral antihypertensive agent for chronic management of pregnancy-induced hypertension (PIH) and preeclampsia in the second and third trimesters.

### Mechanism & Safety Profile

Labetalol is a combined α- and β-adrenergic antagonist that:
- Reduces systemic vascular resistance without reflex tachycardia
- Maintains uteroplacental perfusion (does not cause fetal hypoxia)
- Has extensive safety data in pregnancy with no teratogenic effects
- Achieves BP control within 2–4 hours of oral dosing

### Comparison of Antihypertensives in Pregnancy

| Drug | Trimester Safety | Mechanism | Use in PIH | Notes |
|------|------------------|-----------|-----------|-------|
| **Labetalol** | Safe all trimesters | α/β-blocker | First-line oral | Preferred for chronic management |
| **Methyldopa** | Safe all trimesters | Central α-agonist | Second-line oral | Slower onset; used historically |
| **Nifedipine (ER)** | Safe all trimesters | CCB | First-line alternative | For acute/chronic control |
| **Atenolol** | Avoid (IUGR risk) | β-blocker (selective) | Contraindicated | Associated with fetal growth restriction |
| **ACE inhibitors** | Contraindicated 2nd/3rd | Renal vasodilator | Avoid | Fetal renal dysgenesis, oligohydramnios |
| **Diuretics** | Avoid (↓ plasma volume) | Volume depletion | Avoid | Worsens placental perfusion |

**High-Yield:** In Indian guidelines (FOGSI, ICOG), labetalol and nifedipine are the two first-line agents for PIH; methyldopa is reserved as a second-line option due to slower onset and lower efficacy.

### Clinical Pearl

Labetalol is particularly useful in this patient because:
- She is at 32 weeks (safe in 2nd/3rd trimester)
- She has preeclampsia features (proteinuria + hyperreflexia)
- Oral formulation allows outpatient management if not in labor
- No adverse fetal effects even with prolonged use

**Tip:** Remember the mnemonic **LMNOP** for safe antihypertensives in pregnancy:
- **L**abetalol
- **M**ethyldopa
- **N**ifedipine
- **O**ther (hydralazine — IV only, for acute crisis)
- **P**razosin (rarely used)

[cite:FOGSI Guidelines on Hypertension in Pregnancy], [cite:Harrison 21e Ch 427]

Answer

A. Atenolol

Answer

C. Methyldopa

Answer

D. Enalapril

A 28-year-old primigravida at 32 weeks of gestation presents with blood pressure 158/102 mmHg, proteinuria 2+ on dipstick, and hyperreflexia. She has no symptoms of imminent eclampsia. What is the drug of choice for antihypertensive therapy in this patient?

Explanation

First-Line Antihypertensive in Pregnancy-Induced Hypertension

Mechanism & Safety Profile

Comparison of Antihypertensives in Pregnancy

Clinical Pearl

Practice similar questions

Join our NEET PG community

Drug	Trimester Safety	Mechanism	Use in PIH	Notes
Labetalol	Safe all trimesters	α/β-blocker	First-line oral	Preferred for chronic management
Methyldopa	Safe all trimesters	Central α-agonist	Second-line oral	Slower onset; used historically
Nifedipine (ER)	Safe all trimesters	CCB	First-line alternative	For acute/chronic control
Atenolol	Avoid (IUGR risk)	β-blocker (selective)	Contraindicated	Associated with fetal growth restriction
ACE inhibitors	Contraindicated 2nd/3rd	Renal vasodilator	Avoid	Fetal renal dysgenesis, oligohydramnios
Diuretics	Avoid (↓ plasma volume)	Volume depletion	Avoid	Worsens placental perfusion