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What is the evidence for using labetalol as a first-line treatment option for hypertension in pregnancy?
  1. Louise M Webster,
  2. Andrew J Webb,
  3. Lucy C Chappell
  1. Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, London, UK
  1. Correspondence to Louise M Webster; louise.m.webster{at}kcl.ac.uk

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Key learning points

  • Hypertensive disorders complicate around 8% of pregnancies and are associated with adverse maternal and perinatal outcome

  • The National Institute for Health and Care Excellence (NICE) guidelines do not specify a first-line antihypertensive agent for the treatment of chronic hypertension due to limited evidence in this area

  • Labetalol is recommended by NICE guidelines as first-line antihypertensive treatment for gestational hypertension and pre-eclampsia as it has been proven to be as effective as other antihypertensive agents and is licensed for use in pregnancy

  • Methyldopa and nifedipine are suitable alternative antihypertensive agents for the treatment of hypertension in pregnancy

  • Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists should be stopped within two days of pregnancy notification as they are associated with congenital malformations

  • Selection of antihypertensive treatment in pregnancy should include consideration of pre-existing medication, adverse effect profile and potential teratogenicity

Introduction

Labetalol is a racemate with alpha and non-selective beta adrenoceptor antagonist activity.1 The National Institute for Health and Care Excellence (NICE) recommends labetalol as first-line antihypertensive treatment for non-severe (<160/110 mm Hg) gestational hypertension and pre-eclampsia once blood pressure exceeds 150/100 mm Hg.2 Importantly, the NICE guidelines do not specify a single antihypertensive agent as first line for the treatment of chronic hypertension in pregnancy, but instead suggest women should be offered treatment based on their current antihypertensive prescription, adverse effect profiles and with consideration of potential teratogenicity. Beta blockers (including labetalol) are not recommended as first-line agents by NICE for the treatment of hypertension outside pregnancy and are regarded as fourth-line add-on antihypertensive treatments.3 The recommendation for use of labetalol as first-line treatment in pregnancy is based on limited evidence from randomised controlled trials and influenced by labetalol being the only antihypertensive drug that is licensed for use in pregnancy. Robust safety data for each class of drug, …

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