"...There is no absolutely right drug..."

Q:  I was reading over the Q & A file columns and noticed that Dr. Easterling mentioned using atenolol during pregnancy.  During my second pregnancy I was on methyldopa throughout and had no problems with HELLP (I did have HELLP with my first pregnancy).  I am considering another pregnancy and have been switched to methyldopa (my bp never resolved completely after the first pregnancy).  I am wondering if the drug of choice would be methyldopa or atenolol.  I was also told that methyldopa is considered "safer" for the fetus than other bp drugs.  Thanks a lot for having a website like this!!!! 

A:  There is no absolutely right drug.  Methyldopa worked in your second pregnancy; your doctor is familiar with it.  Those are good reasons to go with that plan.

We use atenolol in SOME patients.  In those patients, we have measured cardiac output and found it to be elevated.  Atenolol reduces BP by reducing cardiac output.  Under these circumstances, atenolol works well for us.

All BP medications have the potential to reduce fetal growth to some degree - usually a small amount that is not clinically important. Except for a specific class of drugs (ACE-inhibitors) a reduction in growth is the only risk that has been demonstrated with BP medications.

Drugs like atenolol and methyldopa have been used extensively. Therefore I would not expect many surprises, which might be found with a newer drug.