Efficacy of Nifedipine versus Hydralazine in the Management of Severe Hypertension in Pregnancy: A Randomised Controlled Trial (original) (raw)
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Comparison of Hydralazine and Nifedipine for Severe Hypertension in Pregnancy
2017
ABSTRACT: The burden of hypertensive disorders during pregnancy and its associated maternal morbidity and mortality is rationale of this study. In our country antenatal care services are far from satisfactory hence incidence of severe hypertension during pregnancy and its morbid complications is very high. Every day our tertiary health care hospitals are receiving complicated cases of severe hypertension during pregnancy with high rate of maternal mortality. Recognition of severe blood pressure and its control is central for preventing intra cerebral haemorrhage that is most commonly attributed cause of maternal death worldwide. Many emergency antihypertensive drugs are being used worldwide under different RCTs with variable results so there is an uncertainty about the agent of first choice. In recent Cochrane database review no anti-hypertensive drug has been proven better than other. There is paucity of prospective studies on the subject in our country therefore, to know the effec...
Comparison of the efficacy of nifedipine and hydralazine in hypertensive crisis in pregnancy
Acta medica Iranica, 2011
Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy. Oral nifedipine is an alternative in management of these patients. In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients. Fifty hypertensive pregnant women were enrolled in the study. A randomized clinical trial was performed, in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction. The primary outcomes measured were the time and doses required for desired blood pressure achievement. Secondary measures included urinary output and maternal and neonatal side effects. The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group (24.0 ± 10.0 min) than intravenus Hydralazine group (34.8 ± 18.8 min) (P ≤ 0.016). Less frequent doses were required with oral nifedipine ...
Journal of Postgraduate Medical Institute, 2016
Objective: To compare oral nifedipine with intravenous hydralazine in their rapidity to control hypertensive emergencies of pregnancy. Methodology: It was a comparative study, done in Gynae C unit, Lady Reading Hospital, Peshawar. The study included hundred patients with severe gestational hypertension ≥160/110 mmHg, randomly assigned to two groups (one given intravenous hydralazine and the other oral nifedipine) to achieve a blood pressure (BP) of ≤150/100 mmHg. BP was measured every 15 minutes for one hour. Side effects were noted in terms of maternal headache and hypotension and fetal heart rate. Results: Both drugs controlled BP in the given time period but hydralazine was more efficacious in terms of time and doses. The time required by hydralazine was 41.10±20.286 minutes as compared to nifidipine was 57.90±21.855 with a significant p value of 0.000. Few doses were required to control BP in case of hydralazine 2.74±1.35 as compared to nifidipine which was 3.86±1.45 with a sign...
Severe Hypertension in Pregnancy: Hydralazine or Labetalol. A Randomized Clinical Trial
Obstetrical & Gynecological Survey, 2006
Objective: The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy. Study design: Two hundred women with severe hypertension in pregnancy were randomized to receive hydralazine (5 mg as a slow bolus dose given intravenously, and repeated every 20 min up to a maximum of five doses) or labetalol (20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min, followed by 80 mg every 20 min up to a maximum dose of 300 mg). The primary end point was successful lowering of blood pressure and maternal hypotension. Results: Women were similar with respect to characteristics at randomization. No significant differences were observed for maternal hypotension or persistent severe hypertension; only two patients in the hydralazine group presented with hypotension. Palpitations ( p = 0.01) and maternal tachycardia ( p = 0.05) occurred significantly more often in patients treated with hydralazine. The main neonatal outcomes were very similar per group; however, hypotension and bradycardia were significantly more frequent in the labetalol group. There were two neonatal deaths per antihypertensive drug group. Conclusions: This randomized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy. #
Objectives: This research work aimed to determine the protection and effectiveness of hydralazine in decreasing the BP (Blood Pressure) in case of severe HTN (Hypertension) in the duration of pregnancy. Methodology: In this research work, the inclusion of the pregnant patients with SBP (Systolic Blood Pressure) of 160.0 mmHg or greater and DBP (Diastolic Blood Pressure) 109.0 mmHg present with eclampsia and in emergency condition of HTN carried out. The starting hydralazine dose was 5.0 milligrams IV bolus then repeated one milligram at an interval of twenty minutes. The measures of the outcome to start the therapy were, SBP, DBP, duration needed to achieve desired level of BP, requirement of total dose, side effects of medicines and feto-maternal outcomes regarding safety and effectiveness of the used medicine. Results: Total 110 patients suffering from eclampsia and HTN emergencies were the participants of this research work. The average age of the mothers was 26.70 ± 6.70 with a range from 18 to 45 years. Before the start of the treatment SBP was 165.50 ± 16.65 mmHg, and DBP was 115.44 ± 8.25 mmHg. After the start of the treatment, an important difference (P = < 0.0010) was detected with decrease in SBP 131.20 ± 9.49 mmHg and in DBP as 93.680 ± 6.30 mmHg. In 85.50% (n: 94) patients, sixty minutes were taken by IV bolus hydralazine, however, in 2.70% (n: 3) patients, there was requirement of more than three hours to control BP. The total dose of medicine needed was less than six milligram in 38. 40% (n: 40) patients, 6.0 to 14.0 milligrams in 40.0% (n: 44) patients and in 15.50% (n: 17) patients, 15.0 to 20.0 milligrams dose was the requirement to control BP. Only 8.18% (n: 9) patients required medicine between 21.0 to 30.0 milligrams IV bolus hydralazine. Conclusion: Hydralazine is much secure and effectual drug to control the BP in severe HTN in the duration of pregnancy as well as after delivery.
Effectiveness of nifedipine compared with other antihypertension on hypertension during pregnancy
Indonesian Journal of Pharmacology and Therapy
Hypertension is the most common complication of pregnancy. It is a major cause of maternal, fetal, and neonatal morbidity and mortality. In this article, the effectiveness of nifedipine compared with other antihypertensives in pregnant women with hypertension was reviewed. The randomized control trial (RCT) of nifedipine and other antihypertension in pregnancy without complications published from 2016 to 2021 in Google Scholar, Cochrane and PubMed were gathered. It was reported that antihypertensives administration to pregnant women with hypertension was very meaningful both for the mother herself and for the fetus or baby. Furthermore, nifedipine has better effectiveness in lowering blood pressure compared to other antihypertensives such as IV labetalol, oral labetalol, IV hydralazine, methyldopa in the treatment of preeclampsia, severe preeclampsia, severe pre-eclampsia/eclampsia, chronic hypertension, hypertension emergency, and severe hypertension.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Severe hypertension in pregnancy (SBP ≥160 mmHg &/or DBP ≥ 110 mmHg) must be treated judiciously to prevent maternal and fetal complications. The study was conducted to compare the efficacy, adverse effects, maternal and fetal outcome between Hydralazine and Labetalol which are the most commonly used drugs for the purpose. Methods: In a prospective study, 130 pregnant patients each with severe hypertension presenting to SMGS Hospital Jammu were randomized in 2 groups and administered hydralazine or labetalol intravenously. The efficacy of the two drugs was measured in terms of number of doses required to obtain target BP and the timing to achieve the same. The incidence of adverse effects, maternal and fetal outcomes were also compared. Comparisons among the two groups was performed by using independent Student's t test for normally distributed variables, Fishers' exact test, and Pearson Chi Square test for categorical variables. The level of significance was set at p<0.05 for all analysis. Results: There was no statistical difference between the two drugs in terms of efficacy. Significantly more low-birth weight infants were born in the hydralazine group. Also, the adverse effects were significantly more in the hydralazine group. Conclusions: Both hydralazine and labetalol can be used to treat hypertensive emergencies of pregnancy but hydralazine is associated with more side effects.
Antihypertensive Drug Therapy for Hypertensive Disorders in Pregnancy
2000
Hypertension in pregnancy is associated with increased maternal and fetal mortality and morbidity. About 8 % of all pregnancies are complicated with hypertensive disorders. There is concordance that severe hypertension should be treated without delay to reduce maternal risks of acute cerebrovascular complications. Intravenous labetalol and oral nifedipine are as effective as intravenous hydralazine in control of severe hypertension, with
Faridpur Medical College Journal
The first line antihypertensive treatment for severe hypertension of pregnancy includes labetalol, hydralazine, or nifedipine. Rapid but safe blood pressure control allows the definitive treatment, the delivery of baby to be carried out with minimal delay and good maternal and fetal outcomes. This non-randomized clinical trial was performed in Faridpur Medical College Hospital to compare the effectiveness and tolerability of oral nifedipine and intravenous labetalol in the acute control of severe hypertension of pregnancy. Total 50 admitted pregnant women with a viable fetus (>_ 24 weeks of gestation) having severe hypertension were allocated into two groups, Group A: 25 patients receiving oral nifedipine (10 mg), Group B: 25 patients receiving injectable labetalol (with incremental doses: 20, 40, 80mg). Up to 5 doses were tried for each drug at 15 minutes interval until target blood pressure (
Severe hypertension in pregnancy: Hydralazine or labetalol
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
Objective: The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy. Study design: Two hundred women with severe hypertension in pregnancy were randomized to receive hydralazine (5 mg as a slow bolus dose given intravenously, and repeated every 20 min up to a maximum of five doses) or labetalol (20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min, followed by 80 mg every 20 min up to a maximum dose of 300 mg). The primary end point was successful lowering of blood pressure and maternal hypotension. Results: Women were similar with respect to characteristics at randomization. No significant differences were observed for maternal hypotension or persistent severe hypertension; only two patients in the hydralazine group presented with hypotension. Palpitations ( p = 0.01) and maternal tachycardia ( p = 0.05) occurred significantly more often in patients treated with hydralazine. The main neonatal outcomes were very similar per group; however, hypotension and bradycardia were significantly more frequent in the labetalol group. There were two neonatal deaths per antihypertensive drug group. Conclusions: This randomized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy. #