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Nifedipine Second-Line Pregnancy Hypertension — ESENeph MCQ

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EasyPregnancy & RenalNifedipine Second-Line Pregnancy HypertensionESENeph

A 29-year-old woman at 36 weeks' gestation with CKD G3b (baseline eGFR 38 mL/min/1.73m2) secondary to reflux nephropathy presents with BP 152/96 mmHg. Her BP at booking was 130/82 mmHg on labetalol 200 mg BD. Urinalysis: protein 2+. Platelets, LFTs, and uric acid are normal. What is the MOST appropriate antihypertensive to add?

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Correct answer: B — Nifedipine modified-release

Nifedipine MR is a recommended second-line antihypertensive in pregnancy when labetalol alone is insufficient, per NICE NG133. ACE inhibitors (ramipril) are absolutely contraindicated in pregnancy due to teratogenicity (renal agenesis, oligohydramnios). Atenolol is associated with fetal growth restriction and is avoided. Doxazosin has limited safety data in pregnancy. Thiazides reduce plasma volume and are generally avoided. Methyldopa is an alternative first-line agent but nifedipine MR is preferred as second-line addition to labetalol.

Reference: NICE 2019 – NG133 Hypertension in Pregnancy; UKKA 2019 – CKD in Pregnancy