<prompt> Which of the following is not used in pre-eclampsia?MethyldopaAtenololLabetalolHydralazine  <response>: B Atenolol?Objectives of treatment of Pre-Eclampsia:To stabilise hypertension to prevent its progression to severe pre-eclampsia.To prevent the complicationsTo prevent eclampsiaDelivery of a healthy baby in optional time.Restoration of the health of the mother in puerperium.ANTIHYPERTENSIVE DRUGS USED IN PREGNANCYThese agents may be used with chronic hypertension DBP100mmHg or acute hypertension DBP105mmHgCentral Alpha agonistsMethyldopa is the drug of choiceBeta blockers Alpha, beta blockersAtenolol, metoprolol labetalo appear safe effective in late pregnancyCalcium antagonistsPotential synergism with magnesium sulfate may lead to precipitous hypotension.?Treatment of Chronic Hypertension:Methyldopa, labetalol nifedipine most common oral agents.AVOID: ACEI ARBs, atenolol, thiazide diureticsWomen in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine.No other additional maternalfetal complications wait until 38w.Oral Antihypertensive for Control of Mild to Moderate Hypertension in Pregnancy. Methyldopa. A drug of first choice; Central peripheral anti adrenergic action. Labetalol. A reasonable alternative; Adrenoceptor antagonist Alpha Beta blocker. Atenolol. To be avoided. Nifedipine. Calcium channel blocker in late pregnancy; Calcium channel blocker. Propranolol. Can be used in late pregnancy. Hydralazine. Add on therapy to Methyldopa; Vascular smooth muscle relaxant. ACE inhibitors. To be avoided. Diuretics. Not to be used as antihypertensiveManagement of HTN disorder:Antihypertensive Therapy:Non-severe hypertension BP:140-15990-10gmmHg-BP goal: wo cormorbid - 130-15580-105-BP goal: wo cormorbid - 13013980-8gDrug of Choice: Methyldopa, labetalol, other beta blockers, CCB nifedipine. I-AACEi ARBs should not be used. II-2EAtenolol prazosin are not recommended.Level A;ACE inhibitors angiotension receptor blockers; Contraindicated in all trimesters of pregnancy.Level B:Woman with severe HTN - require antihypertensive medication for acute BP.Methyldopa Labetalol; a good option for 1st line tx of chronic HTN in pregnancy - based on the overall low rate of adverse effects good efficacy.Atenolol; not currently recommended due to IUGR.Thiazide used in women before pregnancy.No need to be discontinued during pregnancy.Antihypertensives use in Pre-Eclampsia:Have limited value in controlling blood pressure in pre-eclampsia.Indications for anti-hypertensive drugs are:-In persistent rise of blood pressure If diastolic BP110mmHg, if urgent associated with proteinuria.-In severe pre-eclampsia to reduce BP during continued pregnancy during period of induction of labor. 