Drugs for treating severe hypertension in pregnancy: a network meta‐analysis and trial sequential analysis of randomized clinical trials

Abstract

The present evidence suggests similar efficacy between nifedipine, hydralazine and labetalol in the treatment of severe hypertension in pregnancy. Subtle differences may exist in their safety profile. The evidence is inadequate for other drugs.

Toward personalized management of chronic hypertension in pregnancy

“…Although previous metaanalyses have raised concerns about more maternal hypotension with hydralazine, this was not substantiated in a 2018 network meta-analysis that also failed to show an excess of other side effects, such as headache, maternal tachycardia, or stillbirth. 101 Methyldopa is a centrally acting alphareceptor antagonist that decreases sympathetic tone and reduces peripheral vascular resistance. It is available only in an oral formulation.…”

“…By network meta-analysis (51 trials), target BP was achieved in a similar number of women with these medications (or others evaluated) (32 trials, N¼3236 women), although more efficiently with nifedipine than IV hydralazine. 101 Using a minimally important RR reduction of 10% among groups, an associated trial sequential analysis concluded that there was no difference in effectiveness between IV labetalol and oral nifedipine or IV hydralazine, but more data were needed to compare nifedipine and hydralazine. A second network metaanalysis of first-line agents (17 trials, N¼1591 women) found that nifedipine more successfully treated severe hypertension than IV hydralazine.…”

Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence

“…Findings from a recent meta-analysis show that the combination treatment of nifedipine and resveratrol is able to shorten, in pregnancy, the time for achieving target blood pressure (BP) with a relative risk (RR) reduction of −13.9 (95%CI: −22.6; −5.2), compared to nifedipine alone (RR = −3.5, 95%CI: −26.5; 19.7) and labetalol (RR = −1, 95%CI: −22.2; 23) [31], which are the recommended treatments from the International Guidelines for the management of pre-eclampsia [4,5].…”

Which drugs are best for treating severe hypertension in pregnancy?

“…This network analysis of randomised controlled trials compared drugs for severe hypertension in pregnancy 1. The primary outcome was the number of patients achieving target blood pressure (BP).…”