skip to main content

Antihypertensives in Pregnancy — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGeneral CardiologyAntihypertensives in PregnancyEECC

A 30-year-old woman with repaired coarctation of the aorta and an LVEF of 55% wishes to become pregnant. She has mild residual coarctation (arm-leg gradient 15 mmHg), no aortic valve disease, and a normal ascending aorta. She takes amlodipine 5 mg daily. What pre-conception counselling advice regarding her antihypertensive medication is most important?

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

Reveal the answer and explanation

Correct answer: D — Switch amlodipine to labetalol or methyldopa before conception as these are preferred antihypertensives in pregnancy

The 2025 ESC CVD in Pregnancy Guidelines recommend labetalol, methyldopa, or nifedipine (not amlodipine) as first-line antihypertensives in pregnancy. While calcium channel blockers as a class are not absolutely contraindicated, nifedipine has the most safety data in pregnancy. Amlodipine has less pregnancy safety data. ACE inhibitors, ARBs, and ARNIs are contraindicated throughout pregnancy due to teratogenicity. Switching to a pregnancy-safe antihypertensive before conception allows stable BP control. Aspirin 75-100 mg from 12-36 weeks is recommended for pre-eclampsia prevention in at-risk women but does not replace appropriate antihypertensive choice.

Reference: ESC (2025): Guidelines for CVD in Pregnancy