Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy

Giannubilo, Stefano Raffaele; Bezzeccheri, Valeria; Cecchi, Stefano; Landi, Beatrice; Battistoni, Giovanna Irene; Vitali, Paola; Cecchi, L.; Tranquilli, Andrea Luigi

doi:10.1007/s00404-012-2371-x

Cited by 40 publications

(32 citation statements)

References 31 publications

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“…Three antihypertensive drugsnifedipine, methyldopa and labetalol have been demonstrated to be safe for use in the pregnant women and are commonly used for the management of various hypertensive disorders during pregnancy. [10][11][12][13][14][15] Nifedipine is a calcium channel blocker. Methyldopa is a centrallyacting adrenergic antagonist that acts by stimulation of the central alpha 2 receptors, leading to a decrease in sympathetic nerve activity with resultant arterial dilatation ABSTRACT Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Patel

Gadhavi

Gorasia

et al. 2012

Int J Basic Clin Pharmacol

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Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure. [Int J Basic Clin Pharmacol 2012; 1(3.000): 174-177

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Section: Introductionmentioning

confidence: 99%

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Patel

Gadhavi

Gorasia

et al. 2012

Int J Basic Clin Pharmacol

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“…Maternal adverse effects with nifedipine include tachycardia, palpitations, peripheral oedema, headaches, and facial flushing. 5 Rapid acting nifedipine should not be used for treating hypertension or hypertensive emergencies especially in pregnancy because it has been associated with fatal and nonfatal untoward cardiovascular events as well as compromised placental perfusion. 6 Labetalol gives better control of blood pressure compared to other anti-hypertensive agents.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of efficacy of antihypertensive drugs andfeto-maternal outcome in the treatment of pregnancy induced hypertension

Babbar¹,

Armo²,

Bhanja

2015

Int J Reprod Contracept Obstet Gynecol

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Background: Hypertensive disorders are the most common medical disorders in pregnancy contributing significantly to maternal and perinatal mortality and morbidity worldwide. The incidence is around 3-10% of all pregnancies. The aim of antihypertensives is to reduce, stabilize the blood pressure and thus minimize the risks such as placental abruption, maternal cardiac failure, cerebral hemorrhage; but they should not have any adverse effects on the uteroplacental circulation and the fetus. Antihypertensive drugs are often used to lower blood pressure to prevent this progression to adverse outcomes for the mother and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. The aim and objectives of the study was a comparative study of the efficacy of methyldopa, nifedipine versus labetalol and the feto-maternal outcome in gestational hypertension in a tertiary care referral centre. Methods: A prospective study on 240 outpatients as well as inpatients of the antenatal ward of Obstetrics and Gynaecology department of Chhattisgarh Institute of Medical Sciences, Bilaspur which is a tertiary care referral hospital. The patients randomly divided in three groups. The first group received alpha-methyl dopa 250mg tds, second 20 mg bd nifedipine and the third one labetalol 100mg bd. Mean arterial pressure calculated by systolic BP +2 DBP/3.The fall in BP calculated along with time required, dose of drug required, spontaneous/ induced labour or caesarean section, adverse maternal and the fetal outcome was observed. Results: Maximum number of patients that is 145(60.42%) patients belonged to the age group of 19 to 24 years and were primigravida (70.42%) presenting at 33-37 weeks of gestation. Significant fall in MAP was seen in patients receiving nifedipine and labetalol. Mean time to control blood pressure is 46.32 hrs in methyldopa group, 30.44hrs in nifedipine group and 37.24 hrs in labetalol group. 103 (42.9%) patients had normal delivery whereas 137 (57.1%) required a caesarian section, higher rate of spontaneous labour in nifedipine and labetalol group. Most common sideeffect observed was headache; the other side effects included drowsiness, more in patients treated with methyldopa, weakness, more in patients treated with labetalol. The fetal outcome was better with labetalol and nifedipine than methyl-dopa group. Conclusions: The decreased association from maternal and fetal side-effects, the comparatively better hypotensive action indicates that labetalol and nifedipine is suitable for use during pregnancy. Labetalol is safer, quicker in achieving adequate control of blood pressure with considerable prolongation of the duration of pregnancy with fewer side effects on the mother as well as the neonate when used in the management hypertensive disorders of pregnancy.

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“…El amlodipino, un relajador directo del músculo liso vascular con buena tolerancia a largo plazo, recomendado especialmente en hipertensa crónica, se debe tener precaución en disfunción hepática, porque puede prolongar su biodisponibilidad (22), con respecto a su seguridad en la lactancia materna se clasifica como riesgo bajo (nivel 1) es decir bastante seguro, riesgo leve o poco probable (16), se excreta en la leche materna, no se han observado problemas en los lactantes, los niveles plasmáticos son muy bajos en los lactantes de madre que lo han tomado (23).…”

Section: Calcioantagonistasunclassified

Hipertensión/preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura

Martínez

Rendón

Gallego

et al. 2017

Rev. chil. obstet. ginecol.

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Articulo de RevisiónHipertensión/ preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura. RESUMENObjetivo: Establecer recomendaciones en el tipo de antihipertensivo que se debe seleccionar según escenarios clínicos en la hipertensión/preeclampsia postparto, dosis y pautas de seguridad en lactancia. Métodos: Se realizó una búsqueda bibliográfica en inglés y español, utilizando las bases de datos PubMed, Ebsco y Science Direct, tomando como palabras clave los descriptores del Decs (español) y Mesh (inglés), realizando combinaciones con la conjunción Y (AND) y la disyunción O (OR), que hubieran evaluado el manejo, seguimiento en hipertensión y preeclampsia posparto. Como criterio de inclusión se tomaron estudios tipo Revisiones sistemáticas, ensayos clínicos, guías de práctica clínica, estudios observacionales, la calidad de los artículos se evaluó por PRISMA, CONSORT y STROBE según corresponda y se utilizó la herramienta Cochrane para la evaluación del riesgo de sesgos.Resultados: Se identificaron 59 artículos que cumplieron con los requisitos preestablecidos, se encontró que el reconocimiento de la hipertensión posparto es de vital importancia por el riesgo de complicaciones maternas, existe un grupo de mayor riesgo: las que presentaron trastorno hipertensivo ante parto sobre todo severo y con parto pretérmino, de ahí la importancia de vigilar la presión arterial en este periodo. La crisis hipertensiva requiere pronto reconocimiento, evaluación y tratamiento estandarizado para prevenir daño en órgano blanco. Los antihipertensivos de primera línea a utilizar durante la crisis son: labetalol, nifedipino, hidralazina, no existiendo diferencias estadísticas entre ellos con respecto al alcance de metas de control de presión arterial, ni en el tiempo de alcance de estas, tampoco diferencias en resultados adversos maternos perinatales, en la hipertensión no crisis el medicamento a elegir depende de la experticia sobre el fármaco que el clínico tenga, no hay un fármaco superior a otro, y finalmente se encontró que la mayoría de los antihipertensivos utilizados son de amplia seguridad en la lactancia materna, se consideran seguros de riesgo muy bajo (nivel 0) y riesgo bajo (nivel 1).REV CHIL OBSTET GINECOL 2017; 82(2) 220 Conclusiones: Los antihipertensivos de primera línea a utilizar durante la crisis son: labetalol, nifedipino, hidralazina, en la hipertensión no crisis el medicamento a elegir depende de la experticia sobre el fármaco que el clínico tenga, no hay un fármaco superior a otro, y en lactancia materna la mayoría de los antihipertensivos son considerados de amplio margen de seguridad.Palabras clave: posparto, preeclampsia, hipertensión, antihipertensivos, lactancia materna. ABSTRACTObjective: To establish recommendations on the type of antihypertensive that should be selected according to clinical scenarios in postpartum hypertension / preeclampsia, doses and safety guidelines in lactation. Methods: A bibliographic search w...

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Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy

Abstract: Antihypertensive therapy in pregnancy with Labetalol may have the potential to impair fetal behavior in low degrees hypertensive diseases of pregnancy. Optimal care must balance the potentially conflicting risks and benefits to mother and fetus.

Cited by 40 publications

References 31 publications

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

A comparative study of efficacy of antihypertensive drugs andfeto-maternal outcome in the treatment of pregnancy induced hypertension

Hipertensión/preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura

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