Which antihypertensive is considered safe and rational for use in pregnancy?

Methyldopa is considered the antihypertensive of choice in pregnancy because it is safe for both mother and fetus. It works as a centrally acting alpha-2 adrenergic agonist, effectively lowering blood pressure without causing fetal harm. Unlike ACE inhibitors (e.g., lisinopril) and ARBs (e.g., losartan), which are teratogenic and contraindicated in pregnancy, methyldopa has a long history of use and extensive safety data. Beta-blockers like atenolol are generally avoided due to potential fetal growth restriction. Therefore, methyldopa remains the most rational and clinically recommended option for managing hypertension during pregnancy.

Reference: Harrison's Principles of Internal Medicine, J. Larry Jameson, 20th Edition.