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Hypertension — UKMLA MCQ

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A 31-year-old taking ramipril for hypertension says she plans to conceive within the next few months. Her blood pressure is controlled and she is not yet pregnant. What is the best advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Switch from ramipril before conception

NICE advises women taking an ACE inhibitor or ARB who are planning pregnancy to discuss alternative antihypertensive treatment because these drugs carry risks of congenital abnormality and later fetal renal injury. If pregnancy occurs, treatment should be stopped promptly and an appropriate alternative offered, usually within 2 working days. The preconception consultation is the opportunity to change safely while maintaining blood-pressure control. Adding an ARB compounds renin-angiotensin blockade, and abandoning treatment or monitoring also creates avoidable maternal risk.

Reference: NICE NG133, hypertension in pregnancy, pre-pregnancy advice. https://www.nice.org.uk/guidance/ng133/chapter/recommendations