Methyldopa has remained a preferred drug for chronic hypertension in pregnancy largely because of its unmatched safety data. Its antihypertensive mechanism is best described as:

• A Central alpha-2 adrenergic agonist action that reduces sympathetic outflow ✓
• B Direct arterial smooth muscle relaxation with reflex tachycardia
• C Combined alpha and beta receptor blockade
• D Calcium channel blockade in vascular smooth muscle

Explanation

Methyldopa is converted to methylnorepinephrine, a false transmitter that stimulates central alpha-2 receptors, decreasing sympathetic outflow and lowering blood pressure without reducing uteroplacental perfusion. It carries the longest documented follow-up of offspring safety among antihypertensives, which sustains its use despite maternal side effects like sedation, dry mouth, and depression. Direct vasodilatation describes hydralazine, combined blockade describes labetalol, and calcium channel blockade describes nifedipine.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

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Written and medically reviewed by the StethoPrep medical team.