Can I take an angiotensin receptor blocker (ARB) while pregnant?

Angiotensin receptor blockers (ARBs) are FDA Pregnancy Category D agents.^1-8 Women should stop taking an angiotensin receptor blocker (ARB) as soon as possible after pregnancy is detected. ARBs that affect the renin-angiotensin system can cause injury and death to the developing fetus.

The American College of Obstetricians and Gynecologists strongly recommends that women of reproductive age with chronic hypertension not use ARBs, angiotensin converting enzyme inhibitors (ACEIs), renin inhibitors, or mineralocorticoid receptor antagonists, unless there is a compelling reason to do so, such as proteinuric renal disease.⁹

The 2017 American College of Cardiology/American Heart Association hypertension guidelines state that hypertensive women who become pregnant should not be treated with ARBs, angiotensin converting enzyme inhibitors, or direct renin inhibitors [Strong-HARM Recommendation (Level C-LD)].¹⁰ The guideline also recommends that women who are planning to become pregnant or become pregnant should be switched from antihypertensives they are currently taking to either methyldopa, nifedipine, and/or labetalol during pregnancy [Strong Recommendation (Level C-LD)].

^References

1. Diovan [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2017.
2. Edarbi [package insert]. Atlanta, GA: Arbor Pharmaceuticals, LLC; 2016.
3. Atacand [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2016.
4. Avapro [package insert]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; 2016.
5. Cozaar [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015.
6. Teveten [package insert]. North Chicago, IL: AbbVie Inc.; 2014.
7. Micardis [package insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; 2014.
8. Benicar [package insert]. Parsippany, NJ: Daiichi Sankyo, Inc; 2009.
9. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5): 1122-1131.
10. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a reportof the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.