Which medication is typically first-line for severe hypertension in pregnancy?

• A. Hydralazine
• B. Labetalol
• C. Nifedipine
• D. Methyldopa

Answer: (B)

Controlling severe hypertension in pregnancy requires a fast, controlled reduction in blood pressure using a medication that works quickly and is safe for both mother and fetus. Labetalol fits this need because it provides rapid BP lowering through dual alpha- and beta-adrenergic blockade, lowering systemic vascular resistance without causing excessive fetal compromise. In the acute setting, it’s given IV and titrated to reach a safe target, offering reliable control with relatively stable hemodynamics and less reflex tachycardia than some alternatives. This makes it a common first-line choice for severe hypertension in pregnancy. Hydralazine can be effective but may cause more headaches, tachycardia, and fluctuations in BP; nifedipine is another option (often oral or sublingual in some protocols) but starts with a slower onset in many settings; methyldopa is typically used for chronic management and not for acute severe elevations.