Читать книгу Clinical Pharmacology and Therapeutics - Группа авторов - Страница 107
Hypertension
ОглавлениеMany drugs routinely used in the treatment of hypertension are associated with teratogenicity and therefore contraindicated in pregnancy. Labetalol, a beta‐blocker, is used as first‐line treatment of hypertension in pregnant women. Second‐line therapies include nifedipine, a calcium channel blocker and methyldopa. The latter is rarely used outside pregnancy because of adverse effects such as fatigue and dizziness but is safe in pregnancy.
Pregnant women with hypertension should also be offered low‐dose aspirin from 12 weeks to prevent or delay the risk of pre‐eclampsia.
Hydralazine is used intravenously for acute or severe hypertension and also orally as a second‐line agent for chronic hypertension in pregnancy. It can cause tachycardia and headache if given intravenously. Its maternal and foetal effects compare unfavourably with nifedipine and labetalol. There are also reported cases of maternal and foetal lupus‐like syndromes associated with its use.
ACE inhibitors and angiotensin II inhibitors are contraindicated in pregnancy. The use of ACE inhibitors is associated with an increased risk of major congenital malformations after first trimester exposure and causes oligohydramnios, renal dysplasia and pulmonary hypoplasia if administered in the second or third trimester of pregnancy. Ideally they should be discontinued pre‐pregnancy.
Statins are also contraindicated due to reported teratogenesis associated with their use which may be secondary to interference with cholesterol biosynthesis in the foetus.