There are no data from large, well-controlled, random- ized controlled trials directly comparing specific antihyperten- sive agents in pregnancy. Methyldopa has been extensively used in pregnancy and appears to be safe,122 127 including for neonates in a long-term pediatric study.128 A Cochrane review of the use of -blockers in pregnancy noted that these drugs decreased the risk of progression to severe hypertension but may have increased risk for fetal growth restriction (n=1346; RR, 1.36; 95% CI, although this may have been confounded in part by the inclusion of trials that used atenolol, which is not recom- mended in pregnancy because of its known association with fetal Pindolol and metoprolol appear safe for use in pregnancy.131 CCBs appear to be safe in pregnancy, with the most commonly used CCB being nifedipine.132,133 Cochrane review indicated that there was a small increase in the risk for preeclampsia with the use of CCBs versus no ther- Diuretics, predominantly thiazide-type, have been indicated to be safe in and women taking thiazides before pregnancy do not need to discontinue them; however, a 2007 Cochrane review examined the use of diuretics to prevent preeclampsia.135 For thiazides, the reviewers noted that several studies were of uncertain quality and that there was insufficient evidence for any differences between treatment and control groups (4 trials, 1391 Angiotensin-converting enzyme inhibitors, angio- tensin receptor blockers, and direct renin inhibitors are contraindicated at all stages of pregnancy because of teratoge- nicity and adverse fetal outcomes.136 139 Sex and Hypertension in Relation to Prevention of Stroke: Summary and Gaps There is insufficient evidence to warrant a different approach to BP treatment in women from that used for men; as such, the existing guidelines for measurement, identification, and man- agement of BP in adults should be followed. 