Managing hypertension in a breastfeeding mother-to-be

How would you manage a 31-year-old gravida 3 para 3 who is hypertensive (BP 130-160/90-110 mm Hg)? The woman is breastfeeding a 2-month-old infant and wants to continue until the baby's first birthday because he has demonstrated intolerance to multiple formulas. The mother's history includes a sulfa allergy and moderate persistent asthma that is currently well controlled. However, she has required oral steroid therapy in the past. Methyldopa (Aldomet) was attempted but caused excessive fatigue.
—Anna McMaster, MD, Napoleon, Ohio

Calcium channel blockers, diuretics, and ACE inhibitors are transmitted only in very small concentrations through breast milk and should not cause harm to the infant. Thus, the appropriate antihypertensive agent can be used by the mother without concern about adverse affects on the breastfeeding infant.
—Daniel R. Mishell Jr, MD (117-18)

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