A Prospective Controlled Trial of Metoprolol‐hydralazine Treatment in Hypertension During Pregnancy

Högstedt, Stellan; Lindeberg, Solveig; Axelssön, Ove; Lindmark, Gunilla; Rane, Anders; Sandström, B; Lindberg, Bo

doi:10.3109/00016348509156729

Cited by 49 publications

(23 citation statements)

References 20 publications

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“…To estimate the effect of antihypertensive agents in pregnant women with mild to moderate hypertension, we found 18 studies which reported data on stillbirths [10,14,58-73] and twenty studies which reported data on perinatal mortality [14,58,60,61,63-66,68,69,71-80] (Table 3). The effect of antihypertensive drugs showed no effect for stillbirths (RR= 1.14; 95% CI: 0.60 to 2.17) (Figure 4).…”

Section: Resultsmentioning

confidence: 99%

Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

et al. 2011

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BackgroundPre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.MethodsA systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, a Delphi process was undertaken to estimate effectiveness.ResultsWe identified 82 relevant studies. For aspirin, maganesium sulphate and use of antihypertensive we found an insignificant decrease in stillbirth and perinatal mortality. For calcium supplementation, there was a borderline significant reduction in stillbirths (RR 0.81, 95 % CI 0.63-1.03). We undertook a Delphi consultation among experts to assess the potential impact of a package of interventions for the management of pre-eclampsia and eclampsia (antihypertensive, magnesium sulphate and C-section if needed). The Delphi process suggested 20% reduction each in both antepartum and intrapartum stillbirths with the use of this package.ConclusionsDespite promising benefits of calcium supplementation and aspirin use cases on maternal morbidity and eclampsia in high risk cases, further work is needed to ascertain their benefits in relation to stillbirths. The Delphi process undertaken for assessing potential impact of a package of interventions indicated that this could be associated with 20% reduction in stillbirths, for input into LiST.

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Section: Resultsmentioning

confidence: 99%

Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

et al. 2011

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“…Prospective controlled studies of metoprololhydralazine, nifedipine and labetalol-methyldopa treatment administered to pregnant women with mild PIH, unclassifiable hypertension or mild PE showed no significant improvement of pregnancy outcome as compared to the non-treated group. [95][96][97][98] Labetalol had no effect on development of proteinuria in a trial of 114 women with PIH and nifedipine had no effect on PE-related hypocalciuria as compared to the control than those of the non-treated/placebo group. Decrease in mean arterial pressure of 10 mmHg was associated with a 145 g decrease in mean birth weight, as found in a post-hoc analysis.…”

Section: Mild To Moderate Hypertensionmentioning

confidence: 99%

Pregnancy-Induced hypertension

et al. 2015

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pregnancy-induced hypertension (pIh) complicates 6-10% of pregnancies. It is defined as systolic blood pressure (sbp) >140 mmhg and diastolic blood pressure (dbp) >90 mmhg. It is classified as mild (sbp 140-149 and dbp 90-99 mmhg), moderate (sbp 150-159 and dbp 100-109 mmHg) and severe (SBP ≥160 and DBP ≥110 mmHg). PIH refers to one of four conditions: a) pre-existing hypertension, b) gestational hypertension and preeclampsia (pe), c) pre-existing hypertension plus superimposed gestational hypertension with proteinuria and d) unclassifiable hypertension. pIh is a major cause of maternal, fetal and newborn morbidity and mortality. women with pIh are at a greater risk of abruptio placentae, cerebrovascular events, organ failure and disseminated intravascular coagulation. fetuses of these mothers are at greater risk of intrauterine growth retardation, prematurity and intrauterine death. ambulatory blood pressure monitoring over a period of 24 h seems to have a role in predicting deterioration from gestational hypertension to pe. antiplatelet drugs have moderate benefits when used for prevention of pe. treatment of pIh depends on blood pressure levels, gestational age, presence of symptoms and associated risk factors. non-drug management is recommended when sbp ranges between 140-149 mmhg or dbp between 90-99 mmhg. blood pressure thresholds for drug management in pregnancy vary between different health organizations. according to 2013 esh/esc guidelines, antihypertensive treatment is recommended in pregnancy when blood pressure levels are ≥150/95 mmHg. Initiation of antihypertensive treatment at values ≥140/90 mmHg is recommended in women with a) gestational hypertension, with or without proteinuria, b) pre-existing hypertension with the superimposition of gestational hypertension or c) hypertension with asymptomatic organ damage or symptoms at any time during pregnancy. methyldopa is the drug of choice in pregnancy. atenolol and metoprolol appear to be safe and effective in late pregnancy, while labetalol has an efficacy comparable to methyldopa. angiotensin-converting enzyme (ace) inhibitors and angiotensin II antagonists are contraindicated in pregnancy due to their association with increased risk of fetopathy.

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“…Many feel justified to start treatment if there is a rise in BP in the second trimester (4,11). From the mothers' point of view, Hogstedt et al (23) did not find it mandatory with pharmacological treatment in mild to moderate hypertension but they did not differentiate between chronic hypertensive, gestational hypertensive and preeclamptic women. In our study, the pregnancy length was significantly shorter in the group with untreated mild hypertension compared to normal pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Conservative treatment of mild and moderate hypertension in pregnancy

Hjertberg

Belfrage

Hanson

1992

Acta Obstet Gynecol Scand

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In a prospective study regarding conservative treatment of mild to moderate hypertension in pregnancy 5244 women were evaluated at delivery. Two hundred and fifty-eight (4.9%) were registered as hypertensive during pregnancy with a blood pressure (BP) greater than or equal to 140/90 mmHg. One hundred and ninety-six of these continued their pregnancy without medication and 96/196 were defined as preeclamptic (PE), 45/196 as chronic hypertensive (CH), and 55/196 as having gestational hypertension (GH). In 62/258 women antihypertensive treatment was initiated in the mean 6.5 (+/- 8.7) days after onset of hypertension, due to a BP greater than or equal to 150/100 mmHg. There was a later onset of hypertension in the untreated group, and BP at delivery differed in the untreated groups (p less than 0.001) with the lowest BP in women with mild GH. There was no difference in cesarean section rate in the mild hypertensive group as compared to the normal population. Birth weight and length of pregnancy were significantly lower in the untreated mild hypertensive group as compared to normal pregnant women (p less than 0.05). But in the subgroup with mild GH pregnancy length and birth weight did not differ from normal pregnancy. The conclusion from our study is that women with mild hypertension in pregnancy might refrain from antihypertensive therapy if they are closely observed during pregnancy and delivery, especially if there has been no hypertension before pregnancy and no proteinuria develops.

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A Prospective Controlled Trial of Metoprolol‐hydralazine Treatment in Hypertension During Pregnancy

Cited by 49 publications

References 20 publications

Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

Pregnancy-Induced hypertension

Conservative treatment of mild and moderate hypertension in pregnancy

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