Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis

Abstract

Background: Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review aimed to assess the efficacy and safety of antihypertensive drugs in severe hypertension during pregnancy. Methods: A systematic review using the electronic databases MEDLINE (PubMed) and Cochrane Library was performed until August 2021. The risk-of-bias 2 tool was used to assess the risk-of-bias in each study included. Meta-analysis was conducted to assess heterogeneity and to estimate the pooled effects size. Results: Seventeen studies fulfilled the inclusion criteria and 11 were included in the meta-analysis. Nifedipine was estimated to have a low risk in persistent hypertension compared to hydralazine (RR 0.40, 95% CI 0.23–0.71) and labetalol (RR 0.71, 95% CI 0.52–0.97). Dihydralazine was associated with a lower risk of persistent hypertension than ketanserin (RR 5.26, 95% CI 2.01–13.76). No difference was found in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between antihypertensive drugs, except for dihydralazine, which was associated with more adverse effects than ketanserin. Conclusions: Several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, oral methyldopa, IV hydralazine, IV dihydralazine, IV ketanserin, IV nicardipine, IV urapidil, and IV diazoxide. In addition, nifedipine may be preferred as the first-line agent. There was no difference in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between the drugs, except for adverse effects in IV dihydralazine and IV ketanserin.

Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis

“…The specific pharmaceutical to treat hypertension during pregnancy should be carefully selected. Efficacy of antihypertensive pharmaceuticals was assessed by the risk of persistent severe hypertension ( Awaludin et al, 2022 ).…”

Hypertensive crisis: diagnosis, presentation, and treatment

“…Severe preeclampsia is one of the conditions whereby guidelines recommend a more aggressive BP reduction to less than 140 mmHg SBP within 1 h of diagnosis [1]. A recent meta-analysis interestingly found that rapid-acting oral nifedipine resulted in the most sustained BP reduction; however, all the traditional agents: labetalol, nicardipine, and urapidil, were equally effective at the time to BP control [47 ▪ ].…”

The Management of Hypertensive Emergencies—Is There a “Magical” Prescription for All?

“…In a recent meta-analysis, it was demonstrated that oral nifedipine can be considered as a first-line antihypertensive agent for reducing the risk of persistent high BP in pregnancy compared to intravenous hydralazine or labetalol, with no differences in the incidences of adverse effects, maternal or fetal outcomes, or maternal hypotension. For the same purpose, IV hydralazine was more effective than IV ketanserin in controlling BP during pregnancy, with no difference in the risk of maternal hypotension or maternal or fetal outcomes [ 80 ].…”