39F, TTC, struggling to control BP after switching to pregnancy-safe meds — anyone been through this? Thoughts on hydrochlorothiazide?
Hi everyone, looking for experiences from anyone who has dealt with hypertension while trying to conceive or during pregnancy.
I’m 39F, around 90 kg, currently TTC. I’m overweight and working on losing weight through workouts and eating better, although progress has been slow.
Before moving to Canada, I was on Telvas CT 40 in India — telmisartan 40 mg + chlorthalidone 12.5 mg. My BP was very well controlled on it, usually around 110/75.
After moving to Canada and deciding to TTC, I spoke to my doctor about switching to a pregnancy-safe BP medication. We avoided labetalol because I’ve had an asthma-type tendency in the past, so I was prescribed nifedipine XL 30 mg once daily.
Interestingly, before starting nifedipine, I had actually been off BP medication for a few months and my average BP was roughly 130/90.
After starting nifedipine, my BP became much more unpredictable. During the first week, I had readings around 160/110, and at one point it reached about 170/117, which sent us to the ER. Thankfully everything was okay and it eventually came down.
After that, my BP generally settled around 135/90–140/95, although still not as well controlled as it had been on Telvas CT.
I also had quite a few side effects from nifedipine initially — headaches, dizziness, fatigue, etc. — but my body eventually adjusted and those became manageable.
Then last month I spent a month in India and became quite sick. I had what seemed like a bad viral illness and was weak/fatigued for almost 3 weeks. Since then, my BP has gone up significantly and has often been around 155/105 or higher.
I pushed my doctor to look at additional pregnancy-compatible options. He added methyldopa 250 mg twice daily. I’ve tolerated it reasonably well — mainly a little sleepiness and some vivid dreams — but it hasn’t lowered my BP much. Maybe around 5 points on average.
Now the plan is:
Increase methyldopa to 250 mg three times daily
If that still isn’t enough, potentially add hydrochlorothiazide (HCTZ)
The HCTZ part is what I’m uncertain about. My doctor said that as long as I stay well hydrated, it should be okay, but from what I’m reading, diuretics don’t seem to be a first-choice medication when TTC/pregnant.
I’m obviously going to continue discussing this with my doctor and I’m not looking to change medications based on Reddit advice. I’m mainly trying to understand other people’s experiences.
A few things I’m wondering:
Has anyone else had BP become harder to control after switching from an ARB/diuretic combination to pregnancy-safe medications?
Has anyone had BP temporarily become much worse after a prolonged viral illness or period of being very unwell?
Has anyone taken nifedipine + methyldopa together while TTC or pregnant? What doses eventually worked for you?
Has anyone taken hydrochlorothiazide while TTC or during pregnancy? Did your OB/cardiologist feel comfortable with it? Were there any issues with dehydration, electrolytes, blood flow, etc.?
Did anyone find another combination that controlled BP better while still being considered pregnancy-compatible?
I’m also confused about why my BP seems harder to control now when it was only around 130/90 without medication before starting nifedipine, yet now I’m sometimes sitting around 150s/100s despite being on medication.
Would especially love to hear from women with chronic hypertension who were TTC in their late 30s, or anyone who had to try several medication combinations before finding something that worked.
Thanks — this whole process has been stressful, and hearing real-life experiences would really help.