Pregnancy and hypertension meds: Unanswered questions

Drugs for high blood pressure are increasingly prescribed during pregnancy, but what are their benefits and risks?

Nearly 5% of pregnant women are prescribed antihypertensive drugs, including some that may be unsafe for mothers or their children, according to a news release from the American Heart Association (AHA).

“While we know high blood pressure, or hypertension, occurs in about 6% to 8% of all pregnancies, we know little about how women and their doctors treat the condition,” said Brian Bateman, MD, lead author of a study published in AHA’s Hypertension, in the news release.

Bateman and colleagues analyzed a database of more than 1 million pregnant patients with Medicaid from 2000 to 2007. Overall, 4.4% of the patients used antihypertensive drugs during pregnancy; that prevalence increased over the course of the study from 3.5% to 4.9%. The researchers also found that patients who used high blood pressure drugs were older, more likely to have diabetes or kidney disease, and more likely to be white or black than Hispanic or Asian.

Among the antihypertensive agents prescribed to patients were ACE inhibitors and angiotensin receptor blockers, both of which can have harmful adverse effects during pregnancy, the researchers noted.

“We know from reports that a number of harmful effects can occur from using ACE inhibitors or angiotensin receptor blockers, especially during the second and third trimester,” Bateman said in the AHA news release. “These drugs can cause poor growth, kidney problems and even death of the newborn. If women are taking one of these blood pressure medications and they become pregnant or plan to do so, they and their doctors should discuss treatment choices during pregnancy.”

The researchers concluded that more research is “urgently” needed to determine which antihypertensives should be prescribed during pregnancy and how they can be used safely, AHA reported.