Which drug is the first choice for treating hypertension in pregnant women?

Methyldopa is recognized as the first choice for treating hypertension in pregnant women due to its established safety profile and effectiveness. It is an alpha-2 adrenergic agonist that works centrally to reduce sympathetic outflow, thereby lowering blood pressure without adversely affecting uteroplacental blood flow, which is crucial during pregnancy.

The drug has been widely studied and used for many years in this population, demonstrating favorable outcomes for both the mother and the fetus. Its use is particularly favored because it does not pose the risks that certain other antihypertensive agents could. In contrast, agents like enalapril, which is an ACE inhibitor, are contraindicated during pregnancy due to potential harm to fetal development. Hydrochlorothiazide, a thiazide diuretic, may be used, but there is limited evidence on its safety and effectiveness when compared to methyldopa in this setting. Similarly, diltiazem, a calcium channel blocker, while useful in some hypertensive scenarios, is not the primary recommendation for pregnancy-related hypertension.

Thus, methyldopa remains the go-to option, prioritizing the unique considerations of treating hypertension in pregnant women.