Which antihypertensive is most appropriate to manage high blood pressure in a pregnant patient at 25 weeks’ gestation?

• A. Methyldopa
• B. Labetalol
• C. Nifedipine
• D. Hydralazine

Answer: (A)

In pregnancy, the priority is using an antihypertensive with a strong track record of safety for both mother and fetus. Methyldopa fits that need best because it has the longest history of use in pregnancy with extensive safety data. It works centrally by stimulating alpha-2 receptors, reducing sympathetic outflow and producing a gradual, steady drop in blood pressure without causing abrupt changes that could compromise uteroplacental blood flow. At 25 weeks, when ongoing, stable control of hypertension is important, methyldopa is a trusted first-line option in many guidelines.

Other agents like labetalol or nifedipine are also used and effective, but methyldopa’s decades of obstetric experience make it a particularly safe choice for chronic management. Hydralazine is typically reserved for acute hypertensive emergencies in pregnancy rather than routine outpatient management because it can cause rapid pressure drops and adverse maternal/fetal effects.