Full details of the evidence and the committee's discussion are in evidence review D: interventions for pre-eclampsia. Return to recommendations Antihypertensive treatment during the postnatal period, including during breastfeeding Why the committee made the recommendations There was very little evidence on the efficacy and safety of antihypertensive agents in postnatal women, so the committee made recommendations based on the NICE guideline on hypertension in adults, with adaptations based on the potential effects of medicines on the baby. The committee therefore recommended the use of an angiotensin converting enzyme (ACE) inhibitor as first-line treatment, except in women of African or Caribbean family origin, in whom a calcium-channel blocker would be used first line. The choice of second-line medicine was modified from the NICE guideline on hypertension in adults as angiotensin receptor blockers, thiazide and thiazide-like diuretics are not recommended during breastfeeding. Therefore the committee agreed that beta-blockers should be used as the second-line antihypertensive agent. The committee also agreed that the medicines with once-daily administration should be used wherever possible and for this reason the committee recommended enalapril in preference to captopril (which is taken 3 times daily) and atenolol as an alternative to labetalol (which is taken 2 to 4 times daily). Based on their experience, the committee made recommendations on advice for women who wish to breastfeed while taking antihypertensives, and on the monitoring of babies whose mothers are taking antihypertensives. As there was very little evidence on the effectiveness and safety of antihypertensives for postnatal use, the committee revised the research recommendation made in the 2010 guideline. How the recommendations might affect practice There is currently wide variation in practice over use of antihypertensive treatment in the postnatal period, and these recommendations may reduce variation in practice. 