Oral clonidine has resulted in high serum levels in breastfed infants (http://toxnet.nlm.nih.gov/). 1. Antihypertensive drug therapy may be used to keep sBP at 130–155 mmHg and dBP at 80–105 mmHg (I-B; Low/Weak). 1. For women with comorbid conditions, antihypertensive drug therapy should be used to keep sBP at <140 mmHg and dBP at <90 mmHg (III-C; Low/Weak). Management of non-severe pregnancy hypertension is much debated. Any antihypertensive therapy will, compared with placebo or no therapy: decrease transient severe hypertension

(RR selleck inhibitor 0.50; 95% CI 0.41–0.61) without a difference in other outcomes, including preeclampsia or preterm delivery [243]. However, antihypertensive lowering of BP may reduce fetal growth velocity [61], [247] and [248]); not all subsequently published data are consistent with this [344]. The definitive CHIPS Paclitaxel (Control of Hypertension In Pregnancy Study) RCT addressing the issue of BP targets in non-severe hypertension will publish its results in 2014 [345]. No reliable long-term developmental outcome data exist [346] and [347] (see Effect

on long-term child development). Women without comorbid conditions should receive antihypertensives to lower dBP to 80–105 mmHg, recognizing that non-severe hypertension is not an absolute indication for treatment outside pregnancy [7]. The upper dBP acknowledges BP variability, BP measurement inaccuracies, and the desire to avoid a dBP ⩾ 110 mmHg. The lower dBP reflects concern around limiting uteroplacental perfusion [247] and [248], and recommendations outside pregnancy [7]. In contrast, women with comorbid conditions (Table 1) should probably have their BP lowered to <140/90 mmHg. Lower limits for BP goals are unclear. Outside pregnancy, Bay 11-7085 <130/80 mmHg is specified only with diabetes mellitus but to achieve risk reduction over a longer timeframe [7] and [348]. CHEP recommendations provide initial guidance about treatment of secondary causes of hypertension [7]. There is little to guide the choice of antihypertensives in women with or without

co-morbidities. Many antihypertensives have been compared with placebo or no therapy: methyldopa, labetalol, other pure beta-blockers (acebutolol, mepindolol, metoprolol, pindolol, and propranolol), calcium channel blockers (isradipine, nicardipine, nifedipine, and verapamil), hydralazine, prazosin, and ketanserin [246]; ketanserin, isradipine, nicardipine, and mepindolol are not used in Canada. In comparative trials (usually of beta-blockers vs. methyldopa), beta-blockers (i.e., labetalol, pindolol, metoprolol, or oxprenolol) were more effective antihypertensives than methyldopa (RR 0.75; 95% CI 0.58–0.94), without other differences in outcomes [246] and [349] (see ‘Aspects of care specific to women with pre-existing hypertension’ and ‘Effects on long-term child development’). Be familiar with a number of antihypertensive options.