In Reply.
—The cautions noted by Drs Casele and Laifer are appropriate; fortunately, the problems they mention are neither common nor serious. Hypertension is relatively uncommon in women of childbearing age, and most women who are hypertensive are beyond the age when unscheduled pregnancies are more common.
As they note, the only antihypertensive drugs currently used that pose a serious threat to fetal health are the ACE inhibitors (and likely the angiotensin II-receptor blockers). Clearly, ACE inhibitors should not be prescribed for women who may become pregnant. There is little evidence that any of the other classes of antihypertensive drugs pose the threat raised by Casele and Laifer that patients with hypertension may conceive while taking a drug that could cause serious adverse effects in the fetus.
Once the patient conceives, most US obstetricians prefer to use methyldopa or hydralazine because these drugs are the only drugs approved for use in pregnancy.
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