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Antihypertensive drugs during pregnancy:
no ACE inhibitors and no angiontensin II receptor antagonists

ACE inhibitors and angiotensin II receptor antagonists cause serious adverse effects in the unborn child when administered during pregnancy. It is better to opt for other antihypertensives in women of reproductive age.

Angiotensin converting enzyme inhibitors (whose international nonproprietary name, or INN, ends in "-pril") and angiotensin II receptor antagonists (whose INN ends in the suffix -sartan) are marketed for the treatment of high blood pressure.

The serious risks to the unborn child when the mother is exposed to an ACE inhibitor or to an angiotensin II receptor antagonist during the last six months of pregnancy have been known for nearly 20 years. In addition to renal damage, other abnormalities have been reported: abnormal limb formation, lung, facial and cranial abnormalities, bone malformation and abnormality of the dome of the skull, cardiovascular malformations and damage to the nervous system, etc. Malformations of this kind are regularly a cause for concern.

A study carried out in the USA revealed that malformations are around 3 times more frequent in newborns exposed to an ACE inhibitor during the first 3 months of pregnancy than in newborns not exposed to an antihypertensive drug.

When instigating or maintaining an antihypertensive treatment for a pregnant woman, eliminating ACE inhibitors and angiotensin II receptor antagonists can avoid exposing the foetus to a serious risk.

As a rule, it is better to opt for a different antihypertensive drug for women of reproductive age.

©Prescrire May 2007

Source: "IEC et sartans : encore trop de grossesses exposées" Rev Prescrire 2007 ; 27 (283) : 356-357.

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