Blood Pressure Medications and Trying to Conceive
SaveMost blood pressure medicines can continue while trying to conceive, but ACE inhibitors and ARBs such as lisinopril are usually switched to pregnancy-safe options like labetalol first. A preconception medication review lets a clinician adjust your regimen before you conceive while keeping your blood pressure well controlled [1][2].
Last updated: July 2026
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Find care →Are blood pressure medications safe when you're trying to conceive?
Most blood pressure treatment can safely continue while you try to conceive, but a few specific medications are usually switched to pregnancy-compatible options beforehand 1Ref 1American College of Obstetricians and Gynecologists (2019).ACOG Committee Opinion No. 762: Prepregnancy Counseling.Prepregnancy counseling recommends a medication review before conception and switching medications with fetal risk, including ACE inhibitors and ARBs, to safer alternatives2Ref 2National Institute for Health and Care Excellence (2023).Hypertension in pregnancy: diagnosis and management (NG133).Guidance on managing hypertension in pregnancy: avoid ACE inhibitors and ARBs, and use pregnancy-compatible agents such as labetalol, nifedipine, and methyldopa. The reason is not that blood pressure control is risky — uncontrolled high blood pressure is the bigger hazard — but that certain drug classes can affect a developing baby.
Well-managed blood pressure lowers the chance of complications like preeclampsia and growth problems, so the aim is to keep pressure controlled while moving off the medicines that carry fetal risk. About 1 in 4 pregnancies affected by chronic high blood pressure develop preeclampsia, so control and monitoring matter 2Ref 2National Institute for Health and Care Excellence (2023).Hypertension in pregnancy: diagnosis and management (NG133).Guidance on managing hypertension in pregnancy: avoid ACE inhibitors and ARBs, and use pregnancy-compatible agents such as labetalol, nifedipine, and methyldopa4Ref 4American College of Obstetricians and Gynecologists (2018).ACOG Committee Opinion No. 743: Low-Dose Aspirin Use During Pregnancy.Recommends low-dose aspirin from early in the second trimester to lower preeclampsia risk in people at elevated risk, including chronic hypertension. A preconception review, ideally about 3 months before trying, is when a clinician sorts out which of your medicines stay and which change, so nothing runs high during the switch.
Which blood pressure medicines are usually changed before pregnancy?
ACE inhibitors and ARBs — the classes that include lisinopril and losartan — are the medicines guidelines most often move away from before conception 1Ref 1American College of Obstetricians and Gynecologists (2019).ACOG Committee Opinion No. 762: Prepregnancy Counseling.Prepregnancy counseling recommends a medication review before conception and switching medications with fetal risk, including ACE inhibitors and ARBs, to safer alternatives2Ref 2National Institute for Health and Care Excellence (2023).Hypertension in pregnancy: diagnosis and management (NG133).Guidance on managing hypertension in pregnancy: avoid ACE inhibitors and ARBs, and use pregnancy-compatible agents such as labetalol, nifedipine, and methyldopa. National guidance from NICE and ACOG flags these because they can harm a developing baby's kidneys, particularly in the second and third trimesters.
Medicines generally considered compatible with pregnancy include labetalol, nifedipine, and methyldopa, and a clinician can match one to your situation 2Ref 2National Institute for Health and Care Excellence (2023).Hypertension in pregnancy: diagnosis and management (NG133).Guidance on managing hypertension in pregnancy: avoid ACE inhibitors and ARBs, and use pregnancy-compatible agents such as labetalol, nifedipine, and methyldopa. Diuretics and some other agents are handled case by case. None of this means changing anything on your own — the switch is planned with a clinician, often before you conceive, so your numbers stay steady throughout. You can also review side effects of blood pressure medication at that visit.
How does a preconception medication review work?
A preconception medication review is a visit where a clinician goes through every prescription, over-the-counter product, and supplement you use 1Ref 1American College of Obstetricians and Gynecologists (2019).ACOG Committee Opinion No. 762: Prepregnancy Counseling.Prepregnancy counseling recommends a medication review before conception and switching medications with fetal risk, including ACE inhibitors and ARBs, to safer alternatives. Together you look at which medicines are safe to continue, which have safer alternatives, and how to time any change so your blood pressure never runs high in between.
For blood pressure specifically, the large CHAP trial found that treating mild chronic hypertension to a target below 140/90 mmHg improved pregnancy outcomes, and ACOG recommends aiming for good control 3Ref 3Tita AT, Szychowski JM, Boggess K, et al. / Chronic Hypertension and Pregnancy (CHAP) Trial Consortium (2022).Treatment for mild chronic hypertension during pregnancy.CHAP randomized trial showing treatment of mild chronic hypertension in pregnancy to a target below 140/90 mmHg improved pregnancy outcomes. Many people with chronic high blood pressure are also advised to use low-dose aspirin, usually starting at about 12 weeks of pregnancy, to lower preeclampsia risk 4Ref 4American College of Obstetricians and Gynecologists (2018).ACOG Committee Opinion No. 743: Low-Dose Aspirin Use During Pregnancy.Recommends low-dose aspirin from early in the second trimester to lower preeclampsia risk in people at elevated risk, including chronic hypertension. Reviewing your plan early keeps medication safety in pregnancy aligned with your blood pressure goals.
Why does blood pressure matter so much — in pregnancy and after?
Well-controlled blood pressure before and during pregnancy lowers the chance of preeclampsia, preterm birth, and growth restriction 3Ref 3Tita AT, Szychowski JM, Boggess K, et al. / Chronic Hypertension and Pregnancy (CHAP) Trial Consortium (2022).Treatment for mild chronic hypertension during pregnancy.CHAP randomized trial showing treatment of mild chronic hypertension in pregnancy to a target below 140/90 mmHg improved pregnancy outcomes4Ref 4American College of Obstetricians and Gynecologists (2018).ACOG Committee Opinion No. 743: Low-Dose Aspirin Use During Pregnancy.Recommends low-dose aspirin from early in the second trimester to lower preeclampsia risk in people at elevated risk, including chronic hypertension. Getting to a stable regimen before conception matters because the first weeks of pregnancy often pass before a clinician can safely make changes.
There is a longer arc, too. A history of high blood pressure or preeclampsia in pregnancy is linked to a higher risk of heart disease later in life, including through the menopause transition, according to the American Heart Association 5Ref 5Parikh NI, et al. (American Heart Association) (2021).Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association.Scientific statement linking adverse pregnancy outcomes such as hypertension and preeclampsia to higher long-term cardiovascular disease risk in women. That makes preconception blood pressure care an early investment in lifelong heart health. Checking your numbers at home and knowing how often to check blood pressure helps you and your clinician track progress.
When blood pressure medicines and pregnancy plans need a doctor
A primary care clinician or OB can review your full regimen, adjust it well before you conceive, and set up closer monitoring once you are pregnant 1Ref 1American College of Obstetricians and Gynecologists (2019).ACOG Committee Opinion No. 762: Prepregnancy Counseling.Prepregnancy counseling recommends a medication review before conception and switching medications with fetal risk, including ACE inhibitors and ARBs, to safer alternatives2Ref 2National Institute for Health and Care Excellence (2023).Hypertension in pregnancy: diagnosis and management (NG133).Guidance on managing hypertension in pregnancy: avoid ACE inhibitors and ARBs, and use pregnancy-compatible agents such as labetalol, nifedipine, and methyldopa. Because some blood pressure medicines take a little while to swap safely, opening the conversation a few months ahead gives everyone room to get it right.
If you are already trying, or discover a pregnancy while on one of these medicines, that is a common situation a clinician can address quickly rather than something to panic over. You can also learn how to lower blood pressure naturally as part of the plan. Gale can help you organize your medication list before that visit.
Common questions
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Find care →Blood pressure and pregnancy: when to check in
- —Finding out you are pregnant while taking an ACE inhibitor or ARB is a reason to contact your clinician promptly for a medication review.
- —Home blood pressure readings that stay high despite treatment are a reason to seek clinician review before or during a pregnancy attempt.
- —A prior pregnancy with preeclampsia or high blood pressure is a reason to seek preconception review, since it raises future risk.
- —Severe headache, sudden vision changes, or upper-abdominal pain during pregnancy is a reason to seek same-day medical care.
Severe headache, sudden vision changes, trouble breathing, or upper-abdominal pain during pregnancy can signal a blood-pressure emergency such as preeclampsia — seek same-day care or go to the nearest emergency room right away.
This article is general health education, not medical advice. Which blood pressure medicines are right before and during pregnancy depends on your health, and any changes should be made with a primary care clinician or OB, not on your own.
References
- 1.American College of Obstetricians and Gynecologists (2019). ACOG Committee Opinion No. 762: Prepregnancy Counseling. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003013 ✓Prepregnancy counseling recommends a medication review before conception and switching medications with fetal risk, including ACE inhibitors and ARBs, to safer alternatives
- 2.National Institute for Health and Care Excellence (2023). Hypertension in pregnancy: diagnosis and management (NG133). National Institute for Health and Care Excellence (NICE). link ✓Guidance on managing hypertension in pregnancy: avoid ACE inhibitors and ARBs, and use pregnancy-compatible agents such as labetalol, nifedipine, and methyldopa
- 3.Tita AT, Szychowski JM, Boggess K, et al. / Chronic Hypertension and Pregnancy (CHAP) Trial Consortium (2022). Treatment for mild chronic hypertension during pregnancy. New England Journal of Medicine. doi:10.1056/NEJMoa2201295 ✓CHAP randomized trial showing treatment of mild chronic hypertension in pregnancy to a target below 140/90 mmHg improved pregnancy outcomes
- 4.American College of Obstetricians and Gynecologists (2018). ACOG Committee Opinion No. 743: Low-Dose Aspirin Use During Pregnancy. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002708 ✓Recommends low-dose aspirin from early in the second trimester to lower preeclampsia risk in people at elevated risk, including chronic hypertension
- 5.Parikh NI, et al. (American Heart Association) (2021). Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association. Circulation. doi:10.1161/CIR.0000000000000961 ✓Scientific statement linking adverse pregnancy outcomes such as hypertension and preeclampsia to higher long-term cardiovascular disease risk in women
5 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy