Oral beta-blockers for mild to moderate hypertension during pregnancy

Abstract

BackgroundAntihypertensives, such as beta-blockers, are used for pregnancy hypertension in the belief these will improve outcome for mother and baby. ObjectivesTo assess whether oral beta-blockers are better than placebo, or no beta-blocker, and have advantages over other antihypertensives, for women with mild to moderate pregnancy hypertension. Search methodsWe searched the Cochrane Pregnancy and Childbirth Group trials register (January 2004) and bibliographies of retrieved papers and personal files. We updated this search on 4 July 2012 and added the results to the awaiting classification section of the review. Selection criteriaTrials comparing beta-blockers with placebo or no therapy, or other antihypertensives, for women with mild to moderate pregnancy hypertension. Data collection and analysisWe extracted the data independently and were not blinded to trial characteristics or outcomes. Whenever possible, we contacted authors for missing data. Main resultsTwenty-nine trials (approximately 2500 women) are included. Thirteen trials (1480 women) compared beta-blockers with placebo/no beta blocker. Oral beta-blockers decrease the risk of severe hypertension (relative risk (RR) 0.37, 95% confidence interval (CI) 0.26 to 0.53; 11 trials, N = 1128 women) and the need for additional antihypertensives (RR 0.44, 95% CI 0.31 to 0.62; 7 trials, N = 856 women). There are insu icient data for conclusions about the e ect on perinatal mortality or preterm birth. Beta-blockers seem to be associated with an increase in small-for-gestational-age (SGA) infants (RR 1.36, 95% CI 1.02 to 1.82; 12 trials; N = 1346 women). Maternal hospital admission may be decreased, neonatal bradycardia increased and respiratory distress syndrome decreased, but these outcomes are reported in only a small proportion of trials. In 13 trials (854 women), beta-blockers were compared with methyldopa. Beta-blockers appear to be no more e ective and probably equally as safe. Single small trials have compared beta-blockers with hydralazine, nicardipine or isradipine. It is unusual for women to change drugs due to side e ects.Oral beta-blockers for mild to moderate hypertension during pregnancy (Review)

Less-Tight Versus Tight Control of Hypertension in Pregnancy

“…7,8 In contrast, another meta-analysis of randomized, controlled trials involving pregnant women showed that tight control with beta-blockers (including labetalol) was associated with fewer neonatal respiratory complications, but this was subject to potential publication bias. 16 Our findings of no significant between-group differences in the primary or other perinatal outcomes do not support these potential benefits or risks of less-tight versus tight control. Before the start of the trial, the target difference in blood pressure was 5 mm Hg.…”

Less-Tight Versus Tight Control of Hypertension in Pregnancy

“…7,8 In contrast, another meta-analysis of randomized, controlled trials involving pregnant women showed that tight control with beta-blockers (including labetalol) was associated with fewer neonatal respiratory complications, but this was subject to potential publication bias. 16 Our findings of no significant between-group differences in the primary or other perinatal outcomes do not support these potential benefits or risks of less-tight versus tight control. Before the start of the trial, the target difference in blood pressure was 5 mm Hg.…”

Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease

“…Although a previous study reported that β-adrenergic blockers were associated with FGR, 13 a Cochrane review examining mild-moderate hypertension during pregnancy suggested that the relative risk for FGR was low and did not reach statistical significance under the conditions tested; the only exception was 1 study that investigated high doses early in the pregnancy. 19 In the present study, only 1 patient required a dosage higher than that recommended in the drug information. In this patient, 10 mg/day bisoprolol was used, but the patient's infant did not have FGR.…”

Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report

“…As suggested earlier, the avoidance of epinephrine-containing local anaesthetics or agents that trigger tachycardia would also be advisable in these patients. While the use of b-blockers during pregnancy might be associated with an increased risk of small for gestational age infants, 14 we believe that the benefits in our patient clearly exceeded the risks.…”

Less-Tight Versus Tight Control of Hypertension in Pregnancy

“…7,8 In contrast, another meta-analysis of randomized, controlled trials involving pregnant women showed that tight control with beta-blockers (including labetalol) was associated with fewer neonatal respiratory complications, but this was subject to potential publication bias. 16 Our findings of no significant between-group differences in the primary or other perinatal outcomes do not support these potential benefits or risks of less-tight versus tight control. Before the start of the trial, the target difference in blood pressure was 5 mm Hg.…”

Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease

“…Although a previous study reported that β-adrenergic blockers were associated with FGR, 13 a Cochrane review examining mild-moderate hypertension during pregnancy suggested that the relative risk for FGR was low and did not reach statistical significance under the conditions tested; the only exception was 1 study that investigated high doses early in the pregnancy. 19 In the present study, only 1 patient required a dosage higher than that recommended in the drug information. In this patient, 10 mg/day bisoprolol was used, but the patient's infant did not have FGR.…”

Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report

“…As suggested earlier, the avoidance of epinephrine-containing local anaesthetics or agents that trigger tachycardia would also be advisable in these patients. While the use of b-blockers during pregnancy might be associated with an increased risk of small for gestational age infants, 14 we believe that the benefits in our patient clearly exceeded the risks.…”

Less-Tight Versus Tight Control of Hypertension in Pregnancy

“…7,8 In contrast, another meta-analysis of randomized, controlled trials involving pregnant women showed that tight control with beta-blockers (including labetalol) was associated with fewer neonatal respiratory complications, but this was subject to potential publication bias. 16 Our findings of no significant between-group differences in the primary or other perinatal outcomes do not support these potential benefits or risks of less-tight versus tight control. Before the start of the trial, the target difference in blood pressure was 5 mm Hg.…”

Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease

“…Although a previous study reported that β-adrenergic blockers were associated with FGR, 13 a Cochrane review examining mild-moderate hypertension during pregnancy suggested that the relative risk for FGR was low and did not reach statistical significance under the conditions tested; the only exception was 1 study that investigated high doses early in the pregnancy. 19 In the present study, only 1 patient required a dosage higher than that recommended in the drug information. In this patient, 10 mg/day bisoprolol was used, but the patient's infant did not have FGR.…”

Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report

“…As suggested earlier, the avoidance of epinephrine-containing local anaesthetics or agents that trigger tachycardia would also be advisable in these patients. While the use of b-blockers during pregnancy might be associated with an increased risk of small for gestational age infants, 14 we believe that the benefits in our patient clearly exceeded the risks.…”