In the management of acute severe hypertension in a pregnant patient (BP 178/116 mmHg), which of the following antihypertensives has the most rapid onset of action and is used as FIRST-LINE in the acute setting?

• A IV labetalol ✓
• B Oral nifedipine (immediate release)
• C IV hydralazine
• D Sublingual nifedipine

Explanation

IV labetalol (20 mg IV bolus, repeated at 10-minute intervals up to 300 mg) is the most commonly recommended first-line agent for acute severe hypertension in pregnancy due to its rapid, predictable onset and minimal adverse fetal effects. Oral immediate-release nifedipine (10 mg) is also acceptable and widely used. Sublingual nifedipine causes unpredictable BP drop and is contraindicated in pregnancy. IV hydralazine has a delayed and variable onset and is no longer preferred as first-line.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.