Intravenous Isradipine in the Management of Severe Hypertension in Pregnant and Nonpregnant Patients

Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis

“…Hydralazine was associated with a trend towards more persistent severe hypertension (29% (0-32%) compared with nifedipine or isradipine (5% (0-40%); relative risk 1.41 (0.95 to 2.09); four trials; chi; 2 = 11.69, df = 3, P = 0.009; risk difference 0.08 (-0.01 to 0.16); five trials; chi; 2 = 12.36, df = 4, P = 0.02; fig 1) and with use of additional antihypertensives (13% (0-32%) for hydralazine v (5% (0-24%)) nifedipine only; relative risk 2.13 (1.20 to 3.85); four trials; chi; 2 = 5.24, df = 3, P = 0.15; risk difference 0.08 (0.02 to 0.4); five trials; chi; 2 = 12.32, df = 4, P = 0.02), but there was still significant heterogeneity between trials within this subgroup. In the three trials with nifedipine or isradipine in which hydralazine was associated with more severe hypertension, the methods of allocation concealment were either clearly inadequate28 43 or unstated,29 – 31 but other characteristics of the trials did not differ.…”

“…Persistent severe hypertension was variably defined as diastolic blood pressure >= 90 mm Hg,33 >= 95 mm Hg,29 – 31 >=100 mm Hg,41 42 44 47 – 49 or >= 110 mm Hg25 26 28 43; mean arterial blood pressure >= 120 mm Hg45; and failure to achieve a drop in systolic/diastolic blood pressure of 30/15 mm Hg 32. Hydralazine did not differ from other antihypertensives in impact on persistent severe hypertension or on use of additional antihypertensives (table 2).…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Compared with calcium channel blockers, hydralazine may be a less effective antihypertensive and associated with more maternal side effects [315][316][317][318]. Compared with parenteral labetalol, hydralazine may be a more effective antihypertensive but associated with more maternal hypotension and maternal side effects [315,319,320]; however, labetalol is associated with more neonatal bradycardia that may require intervention [315,319,321].…”

Antihypertensive Medications in Management of Gestational Hypertension-Preeclampsia

“…1) and with use of additional antihypertensives (13% [0%-32%] for hydralazine vs. [5% {0%-24%}] nifedipine only; relative risk 2.13 [1.2-3.9]; 4 trials; chi square = 5.24, df = 3, P = 0.15; risk difference 0.08 [0.02-0.14]; 5 trials; chi square = 12.3, df = 4, P = 0.02), but there was still significant heterogeneity between trials within this subgroup. In the 3 trials with nifedipine or isradipine in which hydralazine was associated with more severe hypertension, the methods of allocation concealment were either clearly inadequate 33,38 or unstated, 40 other characteristics of the trials did not differ.…”

“…Adverse effects on fetal heart rate were defined as ''acute fetal distress'' 32,33,36,46 ; need for cesarean section as a result of fetal distress 38 or a decelerative fetal heart rate pattern 48 ; ''deterioration in the cardiotocographic tracings'' 43 ; abnormal fetal heart rate patterns in the 6 hours after treatment 49,50 ; ''abnormal'' fetal heart rate in labor 39 ; fetal heart rate decelerations [40][41][42] ; late decelerations during continuous fetal heart rate monitoring 28 ; or ''CTG abnormalities.'' 27 Hydralazine was associated with more adverse effects on fetal heart rate than other antihypertensives (11% [0%-56%] vs. 0% [0%-50%]), with the significant heterogeneity isolated to the hydralazine vs. labetalol subgroup (Fig.…”