Antihypertensive drugs during pregnancy

Abstract

Hypertensive disorders are the most common medical disorders during pregnancy. Their presence is associated with increased adverse maternal and fetal outcomes both acute and long-term. Antihypertensive agents are widely used in the treatment of these pregnancies despite absent evidence of either benefits or harms from this therapy. Multiple agents are available and various guidelines recommend different agents and various doses and regimens in the absence of information about the pharmacokinetics, disposition, and pharmacodynamic effects of these drugs in pregnancy. Randomized trials comparing antihypertensive therapy to a placebo are lacking and the available data have not shown clinical benefits because of inadequate sample size to rule out even moderate to large effects on perinatal outcome. In addition, data on teratogenic effects, adverse fetal-neonatal effects, and long-term infant outcome are also scant. These problems resulted from lack of interest and support by the government and pharmaceutical companies to conduct research in pregnant women because of regulatory and medical-legal concerns. Consequently, there is an urgent need to conduct clinical research in this area.