A 38-year-old pregnant woman at 34 weeks gestation is found to have BP 158/102 mmHg on two readings 4 hours apart. She has no proteinuria, no oedema, and no symptoms. Maternal platelet count and liver enzymes are normal. Fetal CTG is reactive. What is the MOST appropriate antihypertensive agent?

• A ACE inhibitor (enalapril)
• B Spironolactone
• C Hydrochlorothiazide
• D Labetalol ✓

Explanation

This patient meets criteria for gestational hypertension (BP ≥140/90 mmHg without proteinuria after 20 weeks). Labetalol (combined alpha and beta blocker) is the first-line oral antihypertensive in pregnancy per NICE and ACOG guidelines. Methyldopa and nifedipine (long-acting) are acceptable alternatives. ACE inhibitors and ARBs are teratogenic (oligohydramnios, renal agenesis) and absolutely contraindicated in pregnancy from the second trimester. Spironolactone is an antiandrogen and teratogenic. Thiazides reduce uteroplacental perfusion and are avoided.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.