Which of the following best explains why methyldopa remains an acceptable oral antihypertensive for long-term control of chronic hypertension in pregnancy?
- A It is a direct vasodilator that does not cross the placenta
- B It is a central alpha-2 agonist with the longest safety record across all trimesters including first trimester use ✓
- C It blocks calcium channels in vascular smooth muscle with no fetal effects reported
- D It selectively antagonises peripheral alpha-1 receptors without beta-blockade
Correct answer: B. It is a central alpha-2 agonist with the longest safety record across all trimesters including first trimester use
Explanation
Methyldopa is a centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow. It has over six decades of pregnancy use with no teratogenic signal, making it a traditional first choice especially where cost matters, though maternal depression and drowsiness limit tolerability. It crosses the placenta readily, it is not a vasodilator or calcium channel blocker, and peripheral alpha-1 blockade describes prazosin, not methyldopa, eliminating the other three options cleanly.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.