How to lower blood pressure during pregnancy? List of pills and alternative remedies

Centrally acting alpha-2 agonists

Drugs based on methyldopa from the group of alpha-2 agonists lower blood pressure during pregnancy.
They became especially popular in the late 70s of the previous century. During all this time, not a single case of harm to the mother or child was identified. These medications directly affect the brain. This effect quickly dilates blood vessels and reduces the intensity of heart contractions. Side effects are extremely rare. Among them the most common:

• arterial hypotension;
• dry mouth;
• drowsiness.

In addition to the main drug of the same name, Methyldopa, Dopegit is often prescribed during pregnancy. Both drugs are used for high blood pressure as first-line medications.

conclusions

If high blood pressure is diagnosed during pregnancy, this is a cause for concern.

To minimize all risks for the expectant mother and fetus, the doctor selects blood pressure medications that are allowed during pregnancy, preventing the development of preeclampsia and leg cramps.

In addition, what kind of blood pressure pills are available for pregnant women, the attending physician should tell you what preventive measures should be followed. Independent decisions on the choice of drugs cannot be made, since the risk of harm to the fetus is high.

Alpha-2 adrenergic blockers

Includes Methyldopa and Dopegit tablets for high blood pressure during pregnancy. Medications based on the active component, methyldopa, have been used in treatment for a long time and are characterized by the absence of negative effects.

Due to the dilation of blood vessels and a decrease in heart rate, it leads to quick results. Side effects are possible in rare cases. They are characterized by hypotension, dry mouth, and a desire to sleep.

Dopegit

The drug acts cumulatively, so long-term use ensures effectiveness. Sometimes it is taken before birth. It does not negatively affect the fetus, but the therapy is constantly monitored by the attending physician.

Reduces the synthesis of renin and the resistance of peripheral arteries, thereby normalizing blood flow. In addition, the effect on nerve receptors reduces blood pressure. The calming effect ensures the safety of blood pressure normalization.

Contraindicated:

• in case of allergic reactions to components;
• pheochromocytoma;
• depression;
• hepatitis;
• taking MAO inhibitors;
• when arterial hypotension is established;
• hemolytic anemia.

On a note! The drug does not combine well with other medications

If you are taking other medications, it is important to tell your doctor.

Effective, approved tablets

All approved pills for pregnant women are divided into several drug groups that have different properties.

Beta blockers

This group of medications is best suited for pregnant women. It is worth highlighting Labetalol tablets, which can lower blood pressure without disrupting the heart or worsening blood flow to the kidneys. After use, the drug quickly penetrates the body and the effect is observed after 20 minutes. The result lasts up to a day, depending on what dosage is used. Tablets of this group can be used for hypertension, to relieve crises, and also for aneurysm.

Side effects include:

1. Pain in the head.
2. Quick fatigue.
3. Depressive state.

The tablets must be used with caution for diabetes; tablets are completely prohibited for women with hepatitis and bradycardia. It is not recommended to use beta blockers in the early stages; it is best to use them from mid-pregnancy.

Beta blockers

This drug group includes the following names of medications:

1. Atenolol.
2. Metoprolol.
3. Bisoprolol.

The pills can reduce the negative effects of adrenaline and norepinephrine on the heart. Due to this, the load is reduced, the symptoms of tachycardia, as well as other failures associated with the organ, can be overcome.

This category of drugs reduces the production of renin, which enters the blood, causing the rhythm to decrease. It is these changes that can reduce blood pressure when it increases.

Calcium channel blockers

This category of medications includes 2 approved drugs for pregnant women:

1. Nifedipine.
2. Nimodipine.

The described medications reduce the number of heart contractions, dilate blood vessels and improve blood flow. After taking the pills, there is no negative effect on the fetus, but negative reactions in the expectant mother are possible. For example, blood pressure may drop significantly, the heart’s function may be disrupted, and some may develop fever and headaches.

Experts do not recommend using Nifedipine and magnesium sulfate together. The combination leads to a rapid decrease in pressure, which causes negative consequences.

Antispasmodics

Antispasmodics for pressure make it possible to reduce the tone of the uterus and intestines, due to which the lumen in the vessels increases and the pressure normalizes. Antispasmodic tablets can improve blood circulation in the placenta, reducing the likelihood of abnormalities in the child after birth.

To normalize blood pressure you need to use:

1. Drotaverine.
2. Papaverine.
3. But-shpu.

The products described have a minimal number of contraindications and can be taken by pregnant women. In some cases, a woman may experience nausea, vomiting and insomnia.

Diuretics

A group of diuretics are allowed to be taken to lower blood pressure, but during pregnancy the tablets can only be used under the supervision of a doctor. Pregnant women are allowed to drink:

1. Indapamide.
2. Hydrochlorothiazide.

Uncontrolled diuretics cause disruption of blood circulation in the placenta. It is recommended to use diuretics in later stages. You can also use Furosemide, but tablets can be taken if elevated blood pressure appears due to kidney and heart disease.

Alpha-2 agonists

A similar group of tablets is also approved for pregnant women. You can use the following types of tablets:

1. Methyldopa.
2. Dopengit.

While taking medications during pregnancy for high blood pressure, doctors did not identify any negative consequences. It must be said that pills can affect the brain. After consumption, a rapid expansion of the vascular system occurs, the heart does not contract so often. Side effects include dry mouth, drowsiness and excessive decrease in blood pressure. Negative effects on the female body appear very rarely.

Take tablets 2 times a day, and to increase effectiveness you can increase the dosage. After normalization of the condition, the rate of drug consumption is reduced until complete failure. The course of treatment should not exceed 2 weeks.

Magnesium preparations

This group of tablets includes Magnelis and Magnefar. The tablets can be used without fear; they can reduce blood pressure, dilate blood vessels, and also relieve convulsions. Most often, drugs are used in the form of injections, rather than as tablets.

After use, side effects rarely appear, but if they do occur, the woman feels nausea, double vision, and hot flashes. The exact pills must be prescribed by a doctor.

Vitamins

Vitamin complexes can not only normalize blood pressure, but will also be beneficial for the body and the fetus as a whole. To do this you need to use:

1. Vitrum Prenatal.
2. Femibion.

Vitamins will allow you to enrich the body with the necessary substances, and if you choose the right pills, the functioning of the heart and blood vessels will improve.

Sedatives

Plant-based tablets are used as sedatives; they are safe and do not have a negative effect on either the child or the fetus. Such medications can lower blood pressure without serious danger, but you can take the pills if you are not allergic to their components.

Due to the calming effect, tension in the nervous system is relieved, blood pressure improves and the functioning of the entire cardiovascular system is normalized. Such drugs cause almost no side effects, except drowsiness.

Causes of high blood pressure in pregnant women

In the early stages, blood pressure usually decreases due to changes in hormonal levels. Symptoms of toxicosis such as vomiting, problems with appetite, nausea, help reduce blood pressure.

In the second half of pregnancy, blood pressure rises. Typically, the cause is insulin resistance - reduced sensitivity of tissues to insulin. Its natural development occurs due to changes in hormonal levels. It can lead to hypertension and sometimes even diabetes.

Blood pressure increases due to insulin resistance in 95% of patients, in other cases the reason is different. These may be kidney diseases, disruption of their blood supply due to problems with blood vessels (renovascular hypertension), and kidney tissue may be affected. Therefore, specialists often refer patients for ultrasound examination of the kidneys and Doppler ultrasound of the renal vessels.

In addition to insulin resistance and kidney pathologies, the reasons may be the following:

• lack of magnesium in the body;
• poisoning with heavy metals such as mercury, lead, cadmium;
• excess salt in the diet;
• use of certain drugs.

In rare cases, the causes of secondary arterial hypertension are diseases such as:

• primary hyperaldosteronism;
• thyroid diseases;
• pheochromocytoma;
• Itsenko-Cushing syndrome;
• acromegaly.

Important: The listed pathologies often appear at a young age, so pregnant women require a thorough examination. .

Principles of treatment of arterial hypertension during pregnancy

Hypertension increases the risk of abruption of a normally located placenta, massive coagulopathic bleeding as a result of placental abruption, and can also cause eclampsia, cerebrovascular accident, and retinal detachment [1,12]. Recently, there has been an increase in the prevalence of hypertension during pregnancy due to its chronic forms against the background of an increase in the number of patients with obesity, diabetes mellitus and due to the increasing age of pregnant women. And vice versa - women who develop hypertensive disorders during pregnancy are subsequently at risk for developing obesity, diabetes, and cardiovascular diseases. Children of these women have an increased risk of developing various metabolic and hormonal disorders, cardiovascular pathology [1,4]. The criteria for diagnosing hypertension during pregnancy, according to WHO, are a systolic blood pressure (SBP) level of 140 mmHg. or more or diastolic blood pressure (DBP) 90 mm Hg. or more or an increase in SBP by 25 mm Hg. or more or DBP by 15 mm Hg. Art. compared with blood pressure levels before pregnancy or in the first trimester of pregnancy. It should be noted that during a physiologically occurring pregnancy in the first and second trimesters, a physiological decrease in blood pressure occurs due to hormonal vasodilation; in the third trimester, blood pressure returns to the normal individual level or may slightly exceed it [1,6,8]. The following 4 forms of hypertension in pregnant women are distinguished. • Chronic hypertension (this is hypertension or secondary (symptomatic) hypertension diagnosed before pregnancy or before 20 weeks). • Gestational hypertension (increased blood pressure levels, first recorded after 20 weeks of pregnancy and not accompanied by proteinuria). Most recommendations suggest observation for at least 12 weeks to clarify the form of hypertension and understand the further prognosis. after childbirth. • Preeclampsia/eclampsia (PE) (a pregnancy-specific syndrome that occurs after the 20th week of pregnancy, determined by the presence of hypertension and proteinuria (more than 300 mg of protein in daily urine). However, the presence of edema is not a diagnostic criterion for PE, t .k. during a physiologically proceeding pregnancy, their frequency reaches 60%. Eclampsia is diagnosed if convulsions occur in women with PE that cannot be explained by other reasons. • Preeclampsia/eclampsia against the background of chronic hypertension: a) appearance after 20 weeks. pregnancy, proteinuria for the first time (0.3 g of protein or more in daily urine) or a noticeable increase in previously existing proteinuria; b) progression of hypertension in those women who have up to 20 weeks. pregnancy blood pressure was easily controlled; c) appearance after 20 weeks. signs of multiple organ failure. According to the degree of increase in blood pressure in pregnant women, they distinguish between moderate hypertension (with SBP 140–159 mm Hg and/or DBP 90–109 mm Hg) and severe hypertension (with SBP >160 and/or DBP >110 mm Hg .st.). Distinguishing two degrees of hypertension during pregnancy is of fundamental importance for assessing the prognosis and choosing tactics for managing patients. Severe hypertension in pregnant women is associated with a high risk of stroke. Strokes in women develop equally often both during childbirth and in the early postpartum period and in 90% of cases are hemorrhagic; ischemic strokes are extremely rare. An increase in SBP is more important than DBP in the development of stroke. It was noted that in those women who developed a stroke during pregnancy, childbirth, or shortly after delivery, in 100% of cases the SBP value was 155 mm Hg. and higher, in 95.8% of cases – 160 mm Hg. and higher. Increase in DBP to 110 mm Hg. and higher was observed only in 12.5% ​​of patients who suffered a stroke [4,8,9]. The optimal blood pressure level is below 150/95 mmHg. In the postpartum period, the patient needs additional examination to identify the etiology of hypertension and assess the condition of target organs. After 12 weeks. after childbirth, the diagnosis of gestational hypertension with persistent hypertension should be changed to “hypertension” or one of the possible options for the diagnosis of secondary (symptomatic) hypertension. In cases of spontaneous normalization of blood pressure levels within up to 12 weeks. after childbirth, a diagnosis of transient hypertension is retrospectively established. There is evidence that the recovery period after childbirth in the majority of women who have suffered gestational hypertension and PE, regardless of the severity of hypertension, lasts quite a long time. After 1 month after childbirth, only 43% of these patients have normal blood pressure levels, and even after 6 months. In half of women, blood pressure levels remain elevated. After 3 months (12 weeks) of observation after childbirth, 25% of women who have undergone PE still have hypertension; after 2 years, 40% of these patients show normalization of blood pressure levels [1,4,9]. After identifying hypertension in a pregnant woman, the patient should be examined to clarify the origin of the hypertensive syndrome, determine the severity of hypertension, and identify concomitant organ disorders, including the condition of target organs, placenta and fetus. The examination plan for hypertension includes: – consultations with a general practitioner (cardiologist), neurologist, ophthalmologist, endocrinologist; – instrumental studies: electrocardiography, echocardiography, 24-hour blood pressure monitoring, ultrasound examination of the kidneys, Doppler ultrasound of the renal vessels; – laboratory tests: general blood test, general urinalysis, biochemical blood test (with lipid spectrum), microalbuminuria (MAU). If the diagnosis was not clarified at the stage of pregnancy planning, additional examinations are necessary to exclude the secondary nature of hypertension. If the data obtained are sufficient to clarify the diagnosis, exclude secondary hypertension, and on their basis it is possible to clearly determine the patient’s risk group in accordance with the stratification criteria used for chronic hypertension, and, consequently, the management tactics for the pregnant woman, then the examination can be completed. The second stage involves the use of additional examination methods to clarify the form of secondary hypertension, if any, or to identify possible concomitant diseases [6,8]. One of the most difficult tasks in the treatment of hypertension is the choice of pharmacological drug. In the treatment of hypertension in pregnant women, antihypertensive drugs are often considered, but they have practically lost their clinical significance in other categories of patients with hypertension. For ethical reasons, randomized clinical trials of drugs in pregnant women are limited, and there is virtually no information about the effectiveness and safety of most new drugs for the treatment of hypertension. The main drugs that have justified their use for the treatment of hypertension during pregnancy are central α2-agonists, β-blockers (β-blockers), the α-β blocker labetalol, calcium antagonists (CA) and some myotropic vasodilators [3,5 ,7,11]. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists are contraindicated during pregnancy due to the high risk of intrauterine growth retardation, bone dysplasia with impaired ossification of the cranial vault, shortening of the limbs, oligohydramnios, neonatal renal failure (renal dysgenesis, acute renal failure in fetus or newborn), fetal death is possible [11,14]. Most international and domestic recommendations recognize methyldopa as a first-line drug, which has successfully proven its effectiveness and safety for the mother and fetus; it is used in a dose of 500–2000 mg/day. in 2–3 doses. Despite penetration through the placental barrier, numerous studies have confirmed the absence of serious adverse effects in children. During treatment with the drug, uteroplacental blood flow and fetal hemodynamics remain stable, and perinatal mortality decreases. It was noted that methyldopa does not affect the cardiac output and blood supply to the kidneys in the mother. However, methyldopa has a number of significant disadvantages, mainly associated with its relative “outdatedness” - in comparison with modern antihypertensive drugs, it has much less effectiveness, a short period of action, a fairly large number of adverse reactions with long-term use (depression, drowsiness, dry mouth and orthostatic hypotension), it is characterized by a lack of organoprotective action. Methyldopa may exacerbate the disproportionate fluid retention that is already common during pregnancy. In addition, methyldopa can cause anemia due to a toxic effect on the red bone marrow or on the red blood cells themselves, resulting in hemolysis. When taking methyldopa, antibodies to red blood cells are detected in approximately 20% of patients with hypertension; clinically hemolytic anemia develops in 2% of patients, including children exposed to the drug in utero. In addition, children born to mothers taking methyldopa may develop hypotension in the first day of life [10,13,15]. Another first-line drug for the treatment of hypertension in pregnant women in most foreign guidelines is considered to be the non-selective β- and α-adrenergic blocker labetalol, but labetalol is not registered in the Russian Federation, so there is no experience of its use in our country. According to numerous studies, it is recommended for the treatment of hypertension of varying severity, and appears to be quite safe for the mother and fetus [9,11]. There is caution regarding the use of AKs due to the potential risk of developing teratogenic effects, because calcium is actively involved in the processes of organogenesis. The most studied drug of the AK group is a representative of the dihydropyridine group - nifedipine. Short-acting nifedipine is recommended as a means to quickly lower blood pressure. Extended-release tablets and controlled-release tablets are used for long-term, planned basic therapy of hypertension during gestation. The hypotensive effect of nifedipine is quite stable; in clinical studies, no serious adverse events were noted, in particular the development of severe hypotension in the mother [9,11]. Short-acting nifedipine, when used sublingually, in some cases can provoke a sharp uncontrolled drop in blood pressure, which leads to a decrease in placental blood flow. In this regard, even in emergency care, the drug should not be taken orally. Prolonged forms of nifedipine do not cause a pathological decrease in blood pressure levels, reflex activation of the sympathetic nervous system, and provide effective control over blood pressure levels throughout the day without a significant increase in its variability. In addition, ACs simulate hemodynamics characteristic of physiological pregnancy [3,11]. β-blockers are used as second-line drugs. Their use during pregnancy has been less studied than the use of labetalol. However, most of them, according to the FDA safety classification for use during pregnancy, are, like labetalol, in category C (“risk cannot be excluded”). One of the most significant advantages of drugs in this group is their high antihypertensive effectiveness, which was confirmed even when comparing them with labetalol. Thus, atenolol in a comparative study with labetalol caused a comparable hypotensive effect and did not cause teratogenic effects, bronchospasm or bradycardia. However, children born to mothers taking atenolol had lower body weight (2750±630 g) compared to the group of children whose mothers received labetalol (3280±555 g). Later, a number of other studies showed that antenatal use of atenolol was associated with slower intrauterine growth and lower birth weight. It should be noted that there is evidence of a decrease in the incidence of PE in patients taking atenolol. A study of 56 pregnant women showed that atenolol can reduce the incidence of PE in women with high cardiac output (more than 7.4 L/min before 24 weeks of gestation) from 18 to 3.8%. In 2009, it was revealed that in these women the concentration of fms-like tyrosine kinase type 1 (sFlt-1), recognized as the leading etiological factor of PE, decreases [2,7]. When using propranolol during pregnancy, multiple undesirable effects in the fetus and newborn have been described (intrauterine growth retardation, hypoglycemia, bradycardia, respiratory depression, polycythemia, hyperbilirubinemia, etc.), therefore the drug is not recommended for use during pregnancy. In many national recommendations, metoprolol is considered as the drug of choice among β-blockers in pregnant women, because it has proven to be highly effective, has no effect on fetal weight and has a minimal number of undesirable effects. Despite this, literature data allow us to discuss the possibility of using β-blockers with vasodilating properties as the drugs of choice [1,9]. Data from several randomized clinical trials generally suggest that β-blockers (β-blockers) are effective and safe as antihypertensive therapy in pregnant women. There is an opinion that beta-blockers prescribed in early pregnancy, especially atenolol and propranolol, can cause fetal growth retardation due to an increase in general vascular resistance. At the same time, in a placebo-controlled study using metoprolol, no data were obtained indicating a negative effect of the drug on fetal development. R. von Dadelszen in 2002 [16] conducted a meta-analysis of clinical studies on β-blockers and concluded that fetal growth retardation is not due to the effect of β-blockers, but to a decrease in blood pressure as a result of antihypertensive therapy with any drug, while all antihypertensive drugs are equally reduced the risk of developing severe hypertension by 2 times compared to placebo. When comparing various antihypertensive drugs with each other, no advantages were found regarding the effect on endpoints (development of severe hypertension, maternal and perinatal mortality). In connection with the above, in order to minimize side effects during gestation, it is advisable to give preference to cardioselective β-blockers with vasodilating properties, because this primarily avoids an increase in general peripheral vascular resistance and myometrial tone. The most promising for successful use in the treatment of hypertension in pregnant women is a highly selective β1-blocker with vasodilating and vasoprotective properties - bisoprolol (Bisogamma). By blocking β1-adrenergic receptors of the heart, reducing the formation of cAMP from ATP stimulated by catecholamines, bisoprolol reduces the intracellular current of calcium ions, reduces the heart rate, inhibits conductivity, and reduces myocardial contractility. With increasing dose, it has a β2-adrenergic blocking effect. In the first 24 hours after administration, it reduces cardiac output and increases total peripheral vascular resistance, which peaks after 3 days. returns to the original level. The hypotensive effect is associated with a decrease in minute blood volume, sympathetic stimulation of peripheral vessels, restoration of sensitivity in response to a decrease in blood pressure and an effect on the central nervous system. In addition, the hypotensive effect is due to a decrease in the activity of the renin-angiotensin system. In therapeutic doses, the use of Bisogamma does not have a cardiodepressive effect, does not affect glucose metabolism and does not cause sodium ion retention in the body. Bisogamma does not have direct cytotoxic, mutagenic or teratogenic effects. Its advantages in the treatment of hypertension during pregnancy are: gradual onset of hypotensive action, no effect on circulating blood volume, absence of orthostatic hypotension, reduction in the incidence of respiratory distress syndrome in the newborn. This drug has stable antihypertensive activity and has a mild chronotropic effect. Bisoprolol (Bisogamma) is characterized by high bioavailability, low individual variability in plasma concentrations, moderate lipophilicity and stereospecific structure, and a long half-life, which together makes it possible for its long-term use. The drug is characterized by a low discontinuation rate and the absence of side effects from biochemical, metabolic, renal and hematological parameters during long-term follow-up. Important advantages of this drug, especially when it comes to hypertension in pregnant women, are its high efficiency in correcting endothelial dysfunction and nephroprotective effect. There were no adverse effects of bisoprolol (Bisogamma) on the fetus, as well as on the health, growth and development of children during their first 18 months. life. Side effects of β-blockers include bradycardia, bronchospasm, weakness, drowsiness, dizziness, rarely depression, anxiety; in addition, one should remember the possibility of developing “withdrawal syndrome” [1,2]. Data from observational studies of bisoprolol (Bisogamma) suggest effectiveness and sufficient safety when used in the 2nd–3rd trimesters of pregnancy. In the Russian literature there is data on the effectiveness and absence of side effects of the use of bisoprolol, including as part of low -dose combined therapy, for the treatment of hypertension and heart rhythm disorders in pregnant women. No adverse effect on the fetus was noted [3]. In order to assess the influence of bisoprolol (bisogamma) on the level of daily blood pressure, the frequency of development of PE we examined 25 women aged 21–40 years with a pregnancy period of 20-30 weeks. and gestational ag. Bisoprolol (bisogamma) was used as antihypertensive drugs in a dosage of 2.5–5 mg/day. (13 women) - group 1 or Atenolol in a dosage of 25-50 mg/day. (12 women) - Group 2. Before and after a 4 -week course of hypotensive therapy, they performed a standard clinical and laboratory -diagnostic examination of the mother and fetus, daily blood monitoring. The hypotensive effects of Atenolol and Bisoprolol (Bisogamma) were comparable. The middle garden, when taking Atenolol, decreased from 158 to 121 mm Hg, DAD - from 102 to 80 mm Hg. Under the influence of Bisoprolol (Bisogamma), the middle garden decreased from 159 to 120 mm Hg. (p <0.01), DAD - from 121 to 78 mm Hg (p> 0.01). In the 3rd trimester, PE developed in 5 women group 2 and only in 1 patient of group 1. As a result of the study, it was concluded that Bisoprolol (Bisogamma) with gestational hypertension effectively reduces blood pressure and prevents the development of PE. Thus, the problem of AH in pregnant women is still far from permission and requires combining the efforts of obstetricians and therapists to select the optimal treatment method. Literature 1. Vertkin A.L., Tkacheva O.N., Murashko L.E. et al. Arterial hypertension of pregnant women: diagnosis, tactics of conducting and approaches to treatment. // Attending doctor. - 2006. - No. 3. - P. 25–8. 2. Osadchiy K.K. β -adrenoists for arterial hypertension: focus on bisoprolol // Cardiology. - 2010. - No. 1. - From 84–89. 3. Stryuk R.I., Brytkova Y.V., Bukhonkina Yu.M. et al. Clinical efficiency of antihypertensive therapy with prolonged nifedipine and Bisoprolol of pregnant women with arterial hypertension // Cardiology. - 2008. - No. 4. - S. 29–33. 4. Manukhin I.B., Markova E.V., Markova L.I., Stryuk R.I. Combined low -dos antihypertensive therapy in pregnant women with arterial hypertension and gestosis // Cardiology. - 2012. - No. 1. - p. 32–38. 5. CIFKOVA R. Who is the Treatment of Hypertension in Pregnancy Still So Difficult? // Expert Rev. Cardiovasc. Ther. 2011. Vol. 9 (6). P. 647–649. 6. Clivaz Mariotti L., Saudan P., Landau Cahana R., Pechere - Bertschi A. Hypertension in Pregnancy // Rev. Med. Suisse. 2007. Vol. 3 (124). P. 2015–2016. 7. Hebert MF, Carr DB, Anderson GD et al. Pharmacokinetics and Pharmacodynamics of Atenololo During Pregnancy and Postpartum // J. Clin. Pharmacol. 2005. Vol. 45 (1). P. 25–33. 8. LEEMAN M. Arterial Hypertension in Pregnancy // Rev. Med. Brux. 2008. Vol. 29 (4). P. 340–345. 9. Lindheimer MD, Taler SJ, Cunningham FG American Society of Hypertension. Ash Position Paper: Hypertension in Pregnancy // J. Clin. Hypertens. 2009. Vol. 11 (4). P. 214–225. 10. Mahmud H., Foller M., Lang F. Stimulation of Erythrocyte Cell Membrane Scrambling by Methyldopa // Kidney Blood Press Ress. 2008. Vol. 31 (5). P. 299–306. 11. Montan S. Drugs Used in Hypertensive Diseases in Pregnancy // Curr. Opin. Obstet. Gynecol. 2004. Vol. 16 (2). P. 111–115. 12. Mustafa R., Ahmed S., Gupta A., Venuto Rc a Comprehece Review of Hypertension in Preignancy // J. Pregnancy. 2012. Vol. 5 (3). P. 534–538. 13. Ozdemir OM, Ergin H., Ince T. A NewBorn with Positive Antiglobulin Test Whose Mother Methyldopa in Pregnancy // Turk. J. Pediatr. 2008. Vol. 50 (6). P. 592–594. 14. Podymow T., August P. Update on the Use of Antihypertensave Drugs in Pregnance // Hypertension. 2008. Vol. 51 (4). P. 960–969. 15. Seremak - Mrozikiewicz A., Drews K. Methyldopa in Therapy of Hypertension in Pregnant Women // Ginekol. Pol. 2004. Vol. 75 (2). P. 160–165. 16. Von Dadelszen P., Magee La Fall in Mean Arterial Pressure and Fetal Growth Restriction in Pregnancy Hypertension: An Updated Metaregrewsis // J. Obstet. Gynaecol. Can. 2002. Vol. 24 (12). P. 941–945.

Antihypertensive drugs during pregnancy

Drugs that have an antihypertensive effect during pregnancy must be used very carefully, strictly observing the dosage and duration of the course prescribed by the attending physician, in order to avoid negative effects on the fetus caused by insufficient blood supply to the placenta due to a decrease in blood pressure.

Alpha and beta blockers during pregnancy

Taking beta-blockers is prescribed to prevent premature termination of pregnancy.

There are good reasons to take these drugs:

• beta blockers quickly and effectively reduce blood pressure;
• the risk of side effects when taking drugs of this group for pregnant women is minimal;
• simultaneous use of alpha and beta blockers increases the effectiveness of therapy.

Taking these drugs is undesirable if blood pressure is unstable, due to the fact that they contribute to a sharp decrease in blood pressure.

Calcium antagonists during pregnancy

In the treatment of arterial hypertension syndrome, pregnant women are prescribed drugs - potassium antagonists, which help improve microcirculation and permeability of the heart muscle. These medications can be used no earlier than in the second trimester of pregnancy.

Calcium antagonists have a number of advantages: they minimize the likelihood of having children with insufficient body weight, are absolutely non-toxic to the child, and also reduce the frequency of preeclampsia in early pregnancy.

However, this group of antihypertensive drugs also has a number of disadvantages: blood pressure decreases too quickly, which threatens circulatory disorders in the placenta, the appearance of swelling of the extremities, allergic reactions and dyspeptic disorders.

Diuretics during pregnancy

Diuretic drugs (diuretics) in the treatment of hypertension in pregnant women help reduce blood pressure and eliminate edema. However, like all drugs, diuretics also have side effects associated with a deterioration in the flow of blood into the placenta due to a decrease in fluid volume, additionally caused by early and late gestosis. In addition, while taking diuretics, the electrolyte balance may be disrupted and the concentration of uric acid may increase, which has a negative effect on the condition of the placenta during gestosis.

Drugs for the treatment of hypertension in pregnant women

The use of antihypertensive drugs is indicated for women who are not helped by non-drug correction, the prescription of vitamins, minerals, antispasmodics, sedatives, if the following criteria are present:

• systolic blood pressure more than 150 mm Hg. Art.;
• diastolic blood pressure more than 95 mm Hg. Art.;
• Hypertension is accompanied by left ventricular hypertrophy and renal failure.

Methyldopa is the only drug whose safety has been proven by scientific research. And although the experiments themselves were conducted on animals, long-term observation of women taking the medicine did not reveal any negative effects on the mother’s body or the formation of the child (2).

Other antihypertensive agents have not been adequately studied. Most are recommended when the expected benefits to the mother's health outweigh the risks to the fetus. According to European recommendations, if it is not possible to use methyldopa, labetalol and nifedipine are most suitable during pregnancy (5). Prescribing beta blockers and diuretics is permissible as a last resort.

Central agonists (alpha-2 adrenergic agonists)

Methyldopa is the brightest representative of the group, which affects the central mechanism of pressure regulation. Produced under trade names:

• Dopegit;
• Dopanol;
• Aldomet.

The main advantages of the tablets:

• there is no negative effect on the blood supply to the uterus and fetus;
• does not interfere with the growth and development of the child;
• safe for the mother;
• no delayed adverse effects;
• reduces perinatal mortality - the number of deaths from 22 weeks of pregnancy to 7 days after the birth of the baby.

Disadvantages of the medicine:

• danger of use during 16-20 weeks of pregnancy;
• prevalence of side effects: in 22% of patients the drug causes depression, orthostatic hypotension, and drowsiness.

Another representative of the group, clonidine, is rarely used. In early pregnancy, taking the medication may interfere with the formation of fetal organs. Children born to mothers who used clonidine for blood pressure often have trouble sleeping.

Calcium antagonist (calcium channel blockers)

The most studied representative of the class, safe for pregnant women, is nifedipine. The main indication for use is the ineffectiveness of methyldopa therapy or the presence of contraindications. The use of nifedipine allows you to normalize high blood pressure of any etiology, including stopping a hypertensive crisis.

Benefits of calcium channel blockers:

• do not affect fetal weight gain;
• prevent the formation of blood clots;
• lack of embryotoxicity;
• Prescription in the second trimester reduces the likelihood of developing severe gestosis and some other complications of pregnancy.

The main disadvantages of nifedipine are the possibility of a sharp drop in blood pressure and the prevalence of adverse reactions. The most common side effects:

• increased heart rate;
• swelling of the ankles;
• heaviness in the stomach;
• allergic reactions;
• deficiency of blood supply to the uterus and fetus when taking nifedipine “sublingually”.

Trade names of nifedipine:

• Adalat;
• Cordaflex;
• Corinfar;
• Phenigidine.

Beta blockers

An extensive group of drugs, the use of which in the early stages can lead to disruption of embryo formation. The use of beta blockers is dangerous in children:

• slow heart rate (bradycardia);
• metabolic disorders;
• apnea;
• glucose deficiency.

The negative effect on the fetus is especially pronounced in the popular drug Atenolol. It has been proven that taking it in the first trimester leads to delayed development of the baby.

To minimize the risk, pregnant women are recommended to prescribe cardioselective drugs with intrinsic sympathomimetic activity:

• pindolol (Wisken);
• labetalol (Labrokol, Trandat, Trandol);
• oxprenonol (Trazicor);
• acebutolol (Acecor, Sectral).

Thiazide diuretics

Diuretics are prescribed very carefully, in low doses and always in combination. The mechanism of action of diuretics is due to the removal of excess fluid and sodium ions. As a result, the volume of circulating blood decreases, which is very undesirable during pregnancy. In addition, medications in this group can cross the placenta, causing the baby to:

• disorders of electrolyte metabolism;
• decreased platelet count (thrombocytopenia);
• increased bilirubin levels and the appearance of fetal jaundice.

Therefore, all diuretics are used to treat hypertension in exceptional cases. The main indications for prescribing diuretics are hypertension during pregnancy, which is accompanied by kidney/heart failure and edema.

Of all the tablets, hydrochlorothiazide (Hypothiazide, Ezidrex) is the best tolerated. In emergency situations, it is possible to prescribe a representative of another class of diuretics - furosemide (Lasix).

Complications of hypertension

The main danger of arterial hypertension is the development of a hypertensive crisis. In addition, a woman can expect other dangerous conditions.

1. Atherosclerosis: plaques form on the walls of blood vessels, which significantly disrupts the already improper blood circulation and the supply of necessary elements to the placenta. Arterial hypertension is directly related to atherosclerosis, as these two conditions trigger each other.
2. Injection of antispasmodics to relieve hypertensive crisis

   Severe heart disease: A woman may have a myocardial infarction and, as a result, stillbirth. Coronary arteries narrow due to hypertension, and the heart does not receive blood in the required volume.

3. Kidney diseases: Hypertension is the main cause of pathological processes in the kidneys. Pregnant women may develop kidney failure, which results in poor circulation in the organ.
4. Pathologies of the central nervous system are all due to the same reason of impaired blood circulation. A stroke, a chronic failure of blood circulation in the brain, may occur.
5. Endocrine diseases, visual impairment, metabolic syndrome and many other serious complications.

Hypertensive crisis in pregnant women deserves special attention, since it requires immediate treatment.

Traditional treatment

When a combination of body conditions such as hypertension and pregnancy occurs, the treatment of the pathology should be taken very seriously. Increased blood pressure during pregnancy can worsen the mother's condition and cause a number of complications in the fetus:

• cerebral circulatory disorders in a pregnant woman;
• retinal detachment, which eventually leads to complete blindness;
• deadly convulsions;
• placental abruption, which causes heavy bleeding;
• slowing of fetal development;
• low child's Apgar score;
• strangulation and fetal death.

Reducing high blood pressure in a pregnant woman with conventional antihypertensive drugs is strictly prohibited. For expectant mothers, there are specially developed treatment regimens for hypertension that are safe for both them and their babies. Traditional methods of dealing with the diagnosis of hypertension in pregnant women include:

• Proper organization of rest and work.

Active walks in the fresh air are shown (in the park, in the forest). It is recommended to sleep during the day. During the period of bearing a child, water procedures, especially swimming, are very favorable.

• A balanced diet (filled with all necessary vitamins and microelements).

A pregnant woman needs to eat fractionally (5-6 times a day), in small portions. The diet should be enriched with the maximum amount of vitamins, especially calcium, magnesium, potassium, and B vitamins.

This group of microelements promotes better development of the fetus, as well as preventing the occurrence of hypertension in a woman in labor.

• Periodic consultation with a psychologist.

Such a specialist will be able to identify and help eliminate possible psycho-emotional disorders that may cause frequent increases in blood pressure. It is recommended to protect a pregnant woman from negative emotions at home.

To calm and normalize your psychological state, you need to do yoga or meditation.

• Phytotherapy.

Herbal medicine is one of the safest methods of relieving hypertension. This is treatment with infusions and decoctions of medicinal herbs and plants. There are a huge number of them, they have hypertensive, anti-inflammatory, vasoconstrictor and sedative effects on the body. The necessary fees for preparing infusions should be discussed with your doctor. The most commonly prescribed decoctions are valerian, motherwort, peony, and persen.

• In the presence of neurotic reactions of the body, sedatives and special antihypertensive drugs are prescribed.

Each treatment method is prescribed by the attending physician. It is strictly forbidden to take medications without permission.

Medicines that are strong and considered harmful

A difficult and responsible moment for a doctor is what pills to prescribe for a pregnant woman in order to effectively lower blood pressure. The safety of the child comes first, and lowering blood pressure comes second.

Category A: the lightest remedies: Aspirin in a dosage of up to 150 mg, Magnesium, Magnesia. The drugs did not reveal a threat to the baby in the first and remaining trimesters, so they can be taken by pregnant women.

Category B: Aspirin in doses of 150 mg/day, Methyldopa, Hydrochlorothiazide. No violations or risks were detected.

Category C: Papaverine, Clonidine, Calciferol over 400 IU, Nifedipine, Verapamil, Bisoprolol, Labetalol and Metoprolol. During the experiments, the condition of the fetus worsened.

Category D: Aspirin more than 150 mg. Harmful properties have been proven.

Category X: Developmental change and pathology detected. Products are prohibited for pregnant women or those planning to conceive.

Medicines that lower blood pressure are prohibited: ACE inhibitors, angiotensin-II blockers, calcium antagonist. This fact must be taken into account and not prescribe blood pressure medication on your own without consulting a doctor.

Forecasts for mother and child

The presence of hypertension significantly worsens the course of pregnancy. There is a risk of complications such as:

• gestosis;
• early placental abruption;
• miscarriage;
• premature birth.

If you do not pay attention to heart rhythm disturbances and do not monitor the readings on the tonometer, antenatal fetal death may occur.

Many experts believe that in case of hypertension it is safer to have a planned cesarean section. Among all women who died during pregnancy or childbirth, in 40% of cases this was due to complications of hypertension.

Correctly selected early treatment will help minimize all negative risks and deliver a healthy baby.

What drugs are used

Adrenergic blockers

Blood pressure medications in this group are divided into 2 types:

Beta-blockers are a more suitable drug option for expectant mothers.

• Alpha adrenergic blockers. Dilate blood vessels, improve blood supply to the heart. These blood pressure pills cannot be used during pregnancy and lactation, as they have many side effects. Scientists have proven that taking such antihypertensive drugs by pregnant women causes dwarfism and diabetes in the child.
• Beta blockers. These blood pressure medications are considered safer during pregnancy. They dilate blood vessels and normalize heartbeat. This type of medicine can only be taken in severe cases of hypertension, as they can cause intrauterine growth retardation. Often these drugs have side effects on expectant mothers: dizziness;
• drowsiness;
• headache;
• allergic reactions;
• bradycardia;
• bronchospasm;
• increased contraction of the uterus.

What medications can you take in the early stages?

In the early stages of pregnancy, it is better not to take serious medications to lower blood pressure, unless the situation is critical, of course. The following drugs are allowed to be taken:

• Magnicum.
• Magne B6.
• Folic acid.

These drugs are not antihypertensive; the essence of their action is to saturate the nervous system with vitamins and minerals. They have a general calming effect, promote the normal conduction of nerve impulses, have a positive effect on blood vessels (dilate them), and, therefore, the pressure, which has increased due to stress factors, decreases.

No-shpu can be considered a relatively harmless drug in the early stages of pregnancy. It dilates blood vessels, relaxes smooth muscles and relieves spasms. But lowering blood pressure with the help of this drug is possible only with minor deviations from the norm. Consultation with a doctor is required - No-spa may be contraindicated in some cases.

Long-term blood pressure lowering medications

Along with emergency care, a pregnant woman is prescribed long-acting high blood pressure pills. New leaps must not be allowed. Magnesia is not considered a drug, but is given during preeclampsia for seizures. To prevent high blood pressure, take Magnesium B 6 from the beginning of pregnancy.

If taking Dopegit does not bring results, Nifedipine is prescribed in addition. The product normalizes blood pressure, but is not considered safe for the baby. When a doctor prescribes it for existing contraindications, it is worth listening to a specialist, because the harm from high blood pressure may exceed all other risks.

Methyldopa is the most well-known and effective remedy. The drug is called Dopegit. There are no consequences for the baby or the mother from taking the pills. It effectively reduces the numbers on the tonometer within 4-6 hours, the effect lasts up to 12 hours or more. But if you stop taking it, the pressure will return to high, which will be very difficult for both. In addition to the lowering factor, the drug is characterized by a sedative effect, depresses the nervous system, reduces the risk of developing further gestosis and other consequences. Contraindications for use include anemia, liver disease, and heart disease. There are side effects such as insomnia, depression, swelling.

Important! In severe cases, combined drugs are taken (two or three different drugs), the dosage and name are selected strictly by the doctor. .

Review of safe drugs

Limiting the use of standard antihypertensive drugs forces doctors to adjust blood pressure with less effective drugs from other groups. These include:

• magnesium preparations;
• sedatives of plant origin;
• vitamins B, C, E, folic acid;
• selenium, copper, manganese;
• aspirin;
• antispasmodics.

Magnesium preparations

Magnesium is a natural competitor to calcium, an element that promotes vasospasm and increased blood pressure. They have a very similar structure, chemical properties, and different biological roles. Therefore, magnesium can undergo the same reactions as calcium, but without undesirable consequences.

Sedatives

Anti-anxiety medications are important for controlling blood pressure, especially in the first trimester, which is often accompanied by mood swings. It is safest for pregnant women to take extracts of motherwort, valerian, and peony decoction. Some (but not all) complex herbal remedies are suitable for pregnant women:

• Novo-passit;
• Persen;
• Phytorelax.

Sedative medications containing barbiturates (Corvalol, Valocordin), tranquilizers (Diazepam, Relanium, Valium), bromides (Valocormid, Bromenval) are strictly contraindicated for expectant mothers.

When is self-administration of medications justified?

During gestation, hormonal changes occur in the female body, during which the threat of disruptions in the functioning of the heart and blood vessels increases. Arterial hypertension is a severe pathology. However, its occurrence is a pattern.

Blood production increases 1.5 times during pregnancy. Hence the increased load and overstrain of the heart vessels.

Provocateurs of hypertension are:

• stress reactions;
• hormonal imbalance;
• obesity;
• diabetes;
• hereditary abnormalities of the kidneys and thyroid gland.

Hypertension threatens the health of both mother and child. Only in dangerous situations are high blood pressure pills used - at a parameter of 160/110 mmHg. Art. for pregnant. In other cases, non-drug therapy is suitable.

70% of deaths are due to cardiovascular diseases. The root cause of death lies in sudden changes in pressure

It is important to know what you can drink and what products are best kept away during pregnancy.

The list of blood pressure pills for pregnant women is very limited. They are not recommended to be taken in the early stages; they can cause spontaneous abortion.

There are several groups of tablets for high blood pressure, and each category is characterized by distinctive features.

When should you take medications?

Increased blood pressure during pregnancy does not bode well for either the mother or the fetus.
In this condition, the blood vessels narrow, and the fetus ceases to receive nutrients and oxygen in the required quantities. This, in turn, can cause a slowdown in the growth and development of the fetus, and in addition, an increased risk of developing intrauterine pathologies and neurological disorders. Very high blood pressure in a pregnant woman can provoke placental abruption prematurely; this phenomenon is accompanied by severe bleeding, which threatens the health and life of both the mother and the fetus.

The World Health Organization, as well as the European Heart Association, recommends taking pills to lower blood pressure during pregnancy at levels above 140/90 mmHg. Canadian obstetricians and gynecologists advise taking medications only when diastolic pressure (lower pressure) increases above 90 mmHg.

Important ! If the reading is 160/110, the pregnant woman should be hospitalized.

You need to understand that today there are no completely harmless medications to lower blood pressure in pregnant women, so you should take antihypertensive drugs only on the recommendation of a doctor. Such drugs pose a particular danger in the 1st trimester of pregnancy, when the fetus begins to develop organs.

Antispasmodics

They are represented by Drotaverine, Papaverine, No-shpa. The drugs help eliminate uterine hypertonicity. Stimulate placental blood flow. Minimize the risk of developmental defects in the child.

There are no restrictions. But sometimes there are side effects:

• headache;
• insomnia;
• urge to vomit.

Drotaverine

Pain reliever used for:

• pain in the crown area;
• threatened miscarriage;
• hypertonicity of the uterus.

Release form: injections and tablets. The drug should not be combined with food. The tablets are swallowed completely and washed down with plenty of water.

Take with caution due to teratogenic effects, which leads to abnormal embryonic development.

Restrictions on use:

• individual intolerance;
• liver and kidney dysfunction;
• lack of lactose in the blood;
• atherosclerosis;
• glaucoma.

Side effects:

• diarrhea;
• dizziness;
• fever, rapid heartbeat;
• tachycardia;
• excessive sweating;
• Quincke's edema, epidermal allergy.

List of allowed funds

Treatment of arterial hypertension in pregnant women includes taking antihypertensive drugs. The most effective during gestation and the postpartum period are calcium antagonists or calcium channel blockers, beta-blockers and drugs of the methyldopa group. To get rid of the diagnosis of hypertension in pregnant women, antagonists of the first generations are used, since the third generation of this group has not been studied, therefore, will not be prescribed.

"Magnesium-B6" is the first drug prescribed for hypertension in pregnant women. This is due to the root cause of the pathological condition. The most common reason for the development of hypertension is insulin resistance (decreased sensitivity of tissues to insulin), followed by a lack of magnesium, which does not allow blood vessels to relax. Thus, during pregnancy, hypertension occurs, which is controlled by magnesium-B6. Despite the relative safety of the drug, you should consult a physician before use.

"Dopegit" (Methyldopa) has a hypotensive effect, which is due to its ability to lower heart rate and minute blood volume, which leads to a decrease in peripheral vascular resistance.

A distinctive negative effect of the drug is that it provokes fluid and sodium retention in the body, which leads to vasoconstriction and, as a result, increased blood pressure. Therefore, this drug should be used in combination with saluretics or diuretics.

Hypertension during pregnancy is not dangerous if you can take Dopegit, since this drug is one of the few drugs that can be taken in the early stages of pregnancy (from the first days to 28 weeks). The drug is prescribed for mild to moderate severity in pregnant women.

"Labetalol" is a drug from a group of non-selective alpha and beta adrenergic blockers. The hypotensive effect is due to blocking alpha and beta adrenergic receptors in combination with peripheral vasodilation. The effect of the drug does not change the amount of cardiac output and heart rate. The drug has a strong and rapid effect on blood pressure, so it is important to follow the amount of the drug prescribed by your doctor to prevent overdose and cause hypotension. Research has proven that the effect of the drug during pregnancy does not harm either the mother or the unborn baby.

The drug "Nifedipine", a group of calcium ion antagonists, dilates coronary and peripheral vessels, in particular arterial vessels, which contributes to a beneficial reduction in blood pressure. The drug also reduces the heart’s need for oxygen, which prevents the development of severe heart diseases (myocardial ischemia, arrhythmia, myocardial infarction). A distinctive beneficial property of Nifedipine is the absence of an inhibitory effect on the conduction system of the heart.

"Verapamil" is a drug from the group of calcium channel blockers. Its antihypertensive effect is due to the ability to relieve afterload from the heart and its need for oxygen. As a result, coronary (heart) blood flow increases and coronary vessels dilate. "Verapamil" is excreted in breast milk, so its use during lactation is not relevant.

Methyldopa preparations have a beneficial effect on the nervous regulation of vascular tone, which helps normalize blood pressure levels during arterial hypertension in pregnant women. The action of the drug is accompanied by the removal of afterload from the myocardium and a decrease in the number of its contractions. As a result, cardiac output during systole and peripheral vascular resistance decrease, which together causes hypotension (lower pressure).

The active substance can pass into mother's milk, so its use during lactation is not recommended. The drug should be taken only as prescribed by the attending physician.

There are additional groups of drugs for additional treatment of hypertension in pregnant women that doctors can use.

1. Clonidine preparations (Clonidine, Gemiton, Catapresan) help reduce attacks of tachycardia (increased heartbeat) and lower blood pressure.
2. Saluretics (“Hypothiazide”, “Brinaldix”, “Hygroton”) reduce the effect of antihypertensive drugs.
3. Antispasmodics (“No-shpa”, “Dibazol”, “Eufillin”) are administered only parenterally, as they are used to relieve hypertensive crises. The group of antispasmodic drugs includes magnesium sulfate, which has a strong anticonvulsant effect.
4. Sympatholytic drugs (Octadine, Ismelin, Guanethidine) have a very strong hypotonic effect. Their use is possible only if the benefit to the pregnant woman outweighs the possible risk to the fetus.

All of the above drugs are prescribed and dosed exclusively by the attending physician. Any self-medication can cause a number of serious complications.

Possible pregnancy complications associated with this pathology

Hypertension causes complications during pregnancy. High risk of spontaneous miscarriage, premature birth, fetal death

The condition of the mother and child is deteriorating, so it is important to contact a specialist in time who will help to safely improve their health.

If you do not start treatment or take antihypertensive drugs yourself, then significant harm is caused to the child. The unborn baby develops disturbances in the functioning of internal organs and entire systems.

Consequences of incorrect medication use

Incorrect use of blood pressure pills for pregnant women increases the risk of dangerous consequences:

• Congenital pathologies.
• Allergic manifestations.
• Spontaneous miscarriage.
• Stillbirth.
• Premature birth.
• Behavioral disorders.
• Manifestation of cerebral palsy.
• Delayed intellectual development.

In addition, the harmful effects of drugs can be detected some time after the birth of the child or in later periods.

It is better for the expectant mother to refrain from using any medications unless absolutely necessary, especially in the first trimester of pregnancy. An exception is the situation if the medication is prescribed on the recommendation of a doctor, but in this case you should avoid drugs that do not belong to the first group in the table below:

Magnesium-containing preparations

Magnesium-based drugs have been used in obstetric practice for a long time. They cannot be classified as antihypertensive drugs, since they do not have such an effect. But due to their effect on the nervous system, medications have such effects that they indirectly lower blood pressure in pregnant women:

• general sedative effect;
• normalization of the balance of trace elements and minerals.

There are few side effects of magnesium-containing drugs, the most common among them are:

• double image before the eyes (diplopia);
• a feeling of heat spreading throughout the body;
• nausea to the point of vomiting;
• decreased reaction speed.

Your doctor should tell you which blood pressure pills you can take from the group of magnesium-containing medications. Most often he writes:

• "Magnefar";
• "Magnalek";
• "Medivit magnesium + B6."

The studies did not reveal a single case of a negative effect of magnesium-containing drugs on mother and child when used rationally (on the advice of a doctor).

Drugs for high blood pressure

Let's look at what blood pressure pills you can take during pregnancy:

• "Dopegit" ("Methyldopa"). There is a decrease in blood pressure and increased renal blood flow. Consists of talc, ethylcellulose, sodium carboxymethyl starch, stearic acid, methyldopa sesquihydrate, magnesium stearate. Price – 220-240 rubles;
• "Nifedipine". When taken, the work of the blood vessels is facilitated, the pressure on them is relieved, and the oxygen supply is normalized. Ingredients: magnesium stearate, dihydropyridine, gelatin, lactose, dimethyl, starch. Cost – 40-50 rubles. ;
• "Raunatin." Blood pressure levels decrease, heart function returns to normal, and a calming effect occurs. Ingredients: starch, calcium stearate, glucose, cross-povidone, raunatin. Approximate price – 100-120 rubles. Cannot be taken in the last trimester.
• "Labetalol";
• "Metoprolol."

Treatment without antihypertensive drugs

During pregnancy, every woman needs to consume vitamins and minerals that have a beneficial effect on her and the baby. For example, folic acid reduces the risk of diseases of the child’s nervous system.

In the first trimester, you should also consume iodine, in the second - magnesium and calcium, as they have a beneficial effect on the formation of the skeleton. In later stages, you can limit yourself to calcium and magnesium.

If the pathology manifests itself in a mild form, treatment begins with the following medications:

• Magnesium and preparations that contain it (Magnesium B6, for example). When taken, there is no danger to the development of the fetus. The specialist prescribes them to prevent hypertension or with a corresponding diagnosis of a mild form. A deficiency of this element leads to negative symptoms, including increased blood pressure. When this deficiency is normalized, problems with blood pressure often go away;

• Herbal preparations. They are often prescribed in early pregnancy. Among them are motherwort and valerian. If taken in tablets, the effect will be slow, so it is recommended to make decoctions;
• Medicines that improve blood microcirculation. This group includes Aspirin in small dosages and Dipyridamole. The latter drug is used strictly from the 16th week;
• Antispasmodics. This group includes “Papaverine”. It is taken under constant medical supervision, only in cases where the benefit outweighs the risk.

List of harmful drugs during pregnancy

List of drugs that are dangerous to use during pregnancy:

• "Norethindrone";
• "Dactinomycin";
• "Valproic acid";
• "Democlocycline";
• "Veroshpiron";
• "Aminopterin";
• "Busulfan";
• "Estradiol";
• "Valium";
• "Paramethadione";
• "Acetohexamide";
• "Hydroxyprogesterone";
• "Vinblastine";
• "Norgestrel";
• "Clomiphene";
• "Vincristine";
• "Warfarin";
• "Bleomycin";
• "Convulex";
• "Brufen."

Important: The use of ACE inhibitors and angiotensin-II receptor blockers is contraindicated for pregnant women.

Drugs to quickly lower blood pressure

To quickly reduce blood pressure, you should take blood pressure medications for pregnant women, which will be absolutely safe during this period, namely:

• "Dibazol". It helps with spasm of the smooth muscles of organs and arteries;
• Magnesium sulfate. It is prescribed for manifestations of convulsive syndrome and hypertensive crisis;
• "Papazol." Prescribed for cerebral vasospasm;
• "Nifedipine".

During pregnancy, diuretics help, and women tolerate them well:

• "Arifon";
• "Acrylamide";
• "Indap";
• "Hydrochlorothiazide."

As part of routine therapy, doctors often prescribe medications such as Noshpa and Papaverine.

Long-term medications

To maintain the effect for a long period, a specialist can prescribe high blood pressure pills for pregnant women from the following list:

• "Celiprolol." Use once a day, the effect lasts 24 hours;
• "Indapamide";
• "Amlodipine";
• "Verapamil";
• "Nebivolol";
• "Corinfar";
• "Bisoprolol."

Drugs for severe forms

For severe hypertension (BP levels over 160/90) during pregnancy, combination therapy is recommended. By using several medications, the dosage is minimized. The drugs are considered potent, their toxicity is high, so a small amount of treating substances does not harm the development of the fetus.

Blood pressure levels can be brought back to normal by combining the drug “Methyldopa” with the following drugs:

• beta blocker;
• calcium antagonist;
• dihydropyridine calcium antagonist, beta blocker and diuretic;
• calcium antagonist and diuretic;
• dihydropyridine calcium antagonist, beta blocker and alpha blocker;
• beta blocker and diuretic.

If hypertension occurs due to pheochromocytoma, medications such as an alpha blocker and a beta blocker are combined. A dihydropyridine calcium antagonist and a beta blocker are also used.

Combination therapy is usually used in hospital settings. You should not refuse treatment in the hospital, as doctors will provide additional monitoring of fetal development and the course of pregnancy.

Allowed antihypertensive drugs during pregnancy

Before starting treatment, a complete diagnosis of the health condition is carried out. The doctor recommends keeping a diary where the data of daily blood pressure measurements is recorded.

Only the doctor decides what to take to lower the levels. The treatment regimen depends on the state of health and stage of pregnancy. Drug therapy is indicated if the level exceeds 135 by 95 mmHg. Art.:

• Approved general medications are Presolol, Dopegit, Labetalol.
• For chronic hypertension, Isparidipine.
• If fetal retention develops due to hypertension, you can take the medicine “Methyldopa”.
• Sometimes it is necessary to take diuretics: Indapamide, Klopamide.
• In case of hypertensive crisis, antispasmodics are prescribed: “No-shpa”, “Eufillin”.

If you have a tendency to hypertension, you need to start taking medications such as Magne B6, Magnerot.

"Dopegit" ("Methyldopa")

The drug "Dopegit" effectively reduces blood pressure, has a minimal number of contraindications and does not have a toxic effect on the fetus. Use is considered safe from the 21st week of pregnancy.

The medicinal substance - methyldopa 250 mg, which acts as an active component, reduces the tone of individual centers of the nervous system without a negative effect on the heart.

Tablets are taken before or after meals. The dosage is 2 g per day, divided into four doses. The duration of treatment is 7-10 days.

"Labetalol"

"Labetalol" (action begins after 15 minutes). Use is allowed from the second trimester. The pills do not have a negative effect on the functioning of the cardiac system of a pregnant woman and do not affect the intrauterine growth of the fetus. The drug is taken 200-600 mg 2 times a day.

"Metaprolol", "Atenolol", "Bisoprolol"

The drugs are interchangeable and belong to beta-blockers. They are often prescribed for hypertension, tachycardia, extrasystole, angina pectoris and coronary heart disease. The difference lies in the duration of action and the amount of active substance.

Attention! All beta blockers impair blood flow to the placenta. As a result, there is a high risk of having a low birth weight baby

Therefore, tablets should be taken under the strict supervision of a doctor.

The action of the tablets is aimed at normalizing upper and lower pressure, improving the functioning of the cardiovascular system, and reducing heart rate. A group of medications is prohibited for use in the first trimester of pregnancy.

Diuretics

Diuretic drugs are often prescribed as part of complex therapy in the treatment of hypertension. They are especially often prescribed during a crisis to relieve swelling. They should not be abused, as diuretics disrupt placental circulation and cause problems with the kidneys.

"Nifedipine", "Isradipin"

The tablets reduce blood pressure by reducing the tone of smooth muscles and dilating the arteries. They can be taken only after the 4th month of pregnancy. "Nifedipine" or "Isradipine" can be prescribed only in exceptional cases.

The tablets relax blood vessels, lower blood pressure, prevent sudden changes in blood pressure, and remove sodium ions. The effect after administration begins 20 minutes later. Only a doctor can calculate a safe treatment regimen and dosage. In most cases, 1 tablet is prescribed twice a day for 5-6 days.

List of harmful drugs during pregnancy

It is risky to take medications that belong to the group of ACE inhibitors: Lisinopril, Quinapril, Spirapril.

The condition of the expectant mother and her child is negatively affected by angiotensin receptor blockers. This group of hypertensive drugs includes: Irbesartan, Losartan, Eprosartan.

You cannot take all these medications for any period of time, they are dangerous due to their side effects. The active components reduce blood pressure in the fetus and lead to deformation of its body parts and organs.

What blood pressure pills are recommended for pregnant women?

The arsenal of medications is significantly limited. First aid medications include methyldopa, dihydropyridine calcium antagonists, and cardioselective beta-blockers.

Diuretics and α-blockers are used as additional agents for combination treatment.

List of first aid drugs for pregnant women

Hypertensive patients who took medications before pregnancy can leave them. Excludes angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).

List of reserve drugs for the treatment of hypertension before childbirth

Conditionally safe medications and their combinations

It has been noted that taking any medications for blood pressure during pregnancy can affect the intrauterine development of the fetus or affect the further development of the child. Despite all the risks, there is a list of approved drugs, which differs significantly in medical practices in different countries. Doctors judge the severity of the consequences of drug use based on a few studies on animals, data on women and the development of newborns who were treated during pregnancy, and personal medical experience. Medicines are also prescribed depending on the stage of pregnancy.

Important! The only drug for high blood pressure whose effects were monitored for almost 8 years was Methyldopa: no adverse reactions were detected in mothers, newborns, or developmental abnormalities in children over seven years of age. . Depending on the availability of information about the negative outcome of treatment, drugs for high blood pressure are classified into the following groups:

Depending on the availability of information about the negative outcome of treatment, drugs for high blood pressure are classified into the following groups:

Usually combined:

1. Methyldopa and diuretics (side effects from taking the first medication - swelling, can be controlled with diuretics).
2. Methyldopa and calcium antagonists (the latter change heart rate).
3. Methyldopa and beta blockers (decreased vascular tone, the amount of blood in one ejection).
4. Nifedipine, hydrochlorothiazide, beta blockers.
5. Calcium antagonists, clonidine, diuretics, beta blockers.

What can you take in the second trimester?

The only antihypertensive drug that is considered safe for the mother and child is Methyldopa (Dopegit). Scientists observed the effects of this drug for 8 years, and no adverse reactions were observed in mothers or newborns.

Depending on the information about the negative outcome of therapy, antihypertensive drugs are classified into:

• Safe - Calcium carbonate, Magnesia, Magnicum, small dosages of Aspirin tablets.
• Conditionally safe - Dopegit, Hydrochlorothiazide, Nifidipine.

The last three drugs should be considered in more detail.

Dopegit

An antihypertensive drug that must be taken long-term for therapy to be effective. Therefore, in some cases it is prescribed before the birth itself. Despite the fact that it does not have a negative effect on the fetus, the course of therapy should be monitored by a doctor. Dopengite weakens the resistance of peripheral arteries, which leads to normalization of blood pressure. The drug also has a sedative effect.

Contraindications:

• depression;
• hepatitis;
• hemolytic anemia;
• allergy to components;
• taking MAO inhibitors;
• pheochromocytoma.

Hydrochlorothiazide

A diuretic drug that keeps pressure in the arteries under control. It is not often prescribed, mainly for persistent hypertension during pregnancy. Hydrochlorothiasite removes excess fluid and salt from the body, which leads to a decrease in the overall level of blood pressing on the arteries.

Contraindications:

• 1st trimester;
• diabetes;
• anuria;
• gout;
• individual sensitivity to components.

Nifedipine

Prescribed starting from the 16th week, during this period the threat to the child is reduced to a minimum. With this drug you can quickly reduce your blood pressure, and the effect will last for a long time. Nifidipin:

• improves arterial patency;
• expands their lumen;
• relieves spasm.

Contraindications:

• myocardial infarction;
• chronic heart failure;
• aortic stenosis;
• acute form of ischemic disease;
• cardiogenic shock.

Choosing the safest drug to lower blood pressure during pregnancy and childbirth

High blood pressure pills for pregnant women can lead to dangerous consequences, especially when used in the early period of pregnancy. At this time, the main organs of the fetus are formed, so the child can suffer greatly. Some medications can cause retardation in physical and mental development of the fetus, as well as cause congenital pathologies.

Often, an increase in blood pressure, starting from the second week of pregnancy, is caused not by organic reasons, but by a restructuring of the female body, most often by a lack of potassium and magnesium. In this case, a woman may suffer from headaches and rapid pulse. In this situation, it is quite possible to get by by eating foods rich in these microelements or taking special vitamins.

If a woman was planning to have a child, then she began taking special vitamins for pregnant women long before her pregnancy. Such measures can prevent the development of hypertension. An important way to control the condition is proper nutrition and moderate, within normal limits, weight gain. Lack of control in nutrition, rapid increase in body weight and its serious excess contribute to the development of hypertension and many other diseases dangerous to the fetus and woman.

Another way to control high blood pressure is to reduce the amount of salt in foods, as well as proper drinking regimen. A woman should avoid drinking too much fluid, especially if she is prone to swelling, and should not drink water or other drinks at night. All substances that cause an increase in blood pressure - coffee, cocoa, chocolate, strong tea and other products - should be completely excluded.

If the numbers on the tonometer are too high and cannot be influenced without medication, only the attending physician can select and prescribe a medicine.

How to reduce blood pressure during pregnancy without medications

Prescribing almost any drug is associated with a certain risk for the health of the mother and fetus. Therefore, first, the doctor tries to achieve normalization of blood pressure using non-medicinal methods and only if they are ineffective, selects a treatment regimen using medications.

Pregnant women, regardless of the causes of hypertension, need to:

• limit physical activity, the best option for activity is walking in the fresh air;
• avoid stress and emotional experiences;
• sleep more than 10 hours/day;
• periodically rest lying on your left side (at least 2 hours/day);
• Measure blood pressure 5-6 times a day if its level is above 140-149/90-95 mmHg. Art.;
• eat well; a sharp reduction in salt intake is not necessary;
• add garlic to your daily diet; if nausea occurs, mint infusion, ginger;
• monitor the amount of urine. Daily diuresis should not be less than 750 ml;
• postpone weight loss until the postpartum period. The recommendation is relevant even for obese women.

The standard pharmacological approach to normalize blood pressure is not suitable for expectant mothers. The administration of most antihypertensive drugs worsens uteroplacental and fetoplacental blood circulation. The risk of developmental defects, miscarriage, premature, complicated childbirth increases many times over. Therefore, blood pressure pills are prescribed last.

Before prescribing antihypertensive drugs, vitamin-mineral complexes, sedatives, microcirculation correctors, and antispasmodics are used.

Diuretics

Thiazide diuretics - Indapamide, Clopamide - have a hypotensive, diuretic, and vasoconstrictor effect. Tablets are used in the complex treatment of hypertension. For isolated diastolic pressure, they are prescribed as independent treatments. Pregnant women take 1 tablet per day for 3-5 days.

Like other diuretics, Indapamide is not a first-line drug for an expectant mother.

Attention! Pregnant women are prescribed tablets only for hypertension caused by increased sodium concentration in the blood. .

Nifedipine, Isradipin

The drugs belong to class II calcium antagonists. Nifedipine is a dihydropyridine derivative. Available in the dosage form of prolonged-release tablets with slow release of the active substance.

Nifedipine tablets relieve the tone of the smooth muscles that make up the blood vessels and the uterus. Reduces blood pressure by dilating the arteries. They improve coronary blood flow without inhibiting the activity of the heart muscle.

Indications:

• Arterial hypertension;
• relief of an attack of angina pectoris;
• Raynaud's disease.

Important! Calcium antagonists Nifedipine, Isradipine are used to reduce blood pressure only in emergency cases. The drug has a teratogenic effect on the fetus

Sometimes the blood pressure pills for pregnancy Nifedipine and Isradipine relieve uterine hypertonicity. This prevents the threat of miscarriage. But they can be used no earlier than 16 weeks of gestation.

Side effects:

• tachycardia;
• facial redness;
• headache;
• swelling of the limbs.

Nifedipine passes into breast milk. A nursing mother is prohibited from breastfeeding her baby during treatment. For liver and kidney diseases, the drug is used only in a clinical setting.

Prohibited drugs

Many chemicals are dangerous for the mother and her fetus.

Drugs to reduce blood pressure during pregnancy are contraindicated:

• ACE inhibitors – angiotensin-converting enzyme inhibitors;
• ARBs – drugs that block angiotensin receptors;
• Angiotensin II receptor antagonists;
• Rauwolfia preparations.

Particular caution should be exercised when using little-known advertised medications. Many antihypertensive drugs can cause fetal deformities when taken over a long period of time.