A 32-year-old with gestational hypertension at 36 weeks has BP 155/100 mmHg. She has no proteinuria and no severe features. Which antihypertensive is the drug of first choice for acute BP control in this situation?
- A Enalapril 5 mg IV
- B Labetalol 20 mg IV, repeated every 10 minutes as needed ✓
- C Sodium nitroprusside infusion
- D Amlodipine 10 mg oral
Correct answer: B. Labetalol 20 mg IV, repeated every 10 minutes as needed
Explanation
For acute severe hypertension in pregnancy (BP ≥160/110 mmHg) or urgent situations with significant elevation, IV labetalol (20 mg initial dose, can repeat up to 80 mg; max 300 mg) or IV hydralazine are first-line agents per ACOG guidelines. ACE inhibitors (enalapril) are absolutely contraindicated in pregnancy due to fetal renal agenesis and oligohydramnios. Nitroprusside causes fetal cyanide toxicity and is reserved for extreme refractory cases after delivery. Amlodipine is used for chronic management, not acute control.
Reference: Williams Obstetrics, 26th ed.
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