Oral Nifedipine versus Intravenous Labetalol for Acute Blood Pressure Control in Severe Hypertension of Pregnancy: A Study at Faridpur Medical College Hospital

Abstract

The first line antihypertensive treatment for severe hypertension of pregnancy includes labetalol, hydralazine, or nifedipine. Rapid but safe blood pressure control allows the definitive treatment, the delivery of baby to be carried out with minimal delay and good maternal and fetal outcomes. This non-randomized clinical trial was performed in Faridpur Medical College Hospital to compare the effectiveness and tolerability of oral nifedipine and intravenous labetalol in the acute control of severe hypertension of pregnancy. Total 50 admitted pregnant women with a viable fetus (>_ 24 weeks of gestation) having severe hypertension were allocated into two groups, Group A: 25 patients receiving oral nifedipine (10 mg), Group B: 25 patients receiving injectable labetalol (with incremental doses: 20, 40, 80mg). Up to 5 doses were tried for each drug at 15 minutes interval until target blood pressure (<_150/100 mmHg) was achieved. Baseline characteristics like mean age, mean weight, heart rate, systolic and diastolic pressures were similar in both labetalol and nifedipine groups. The average time required to achieve target blood pressure was 30.33 ± 10.44 minutes for labetalol and 25.63 ± 10.12 minutes for nifedipine (p=0.9129). Feto-maternal outcomes and adverse drug related effects were similar among the two groups. Both intravenous labetalol and oral nifedipine were found to be equally effective and well tolerated. Nifedipine may be preferable as it is a simple, flat dose schedule and an oral regimen.
 Faridpur Med. Coll. J. 2021;16(1):25-29

Effectiveness of nifedipine, labetalol, and hydralazine as emergency antihypertension in severe preeclampsia

“…The blood pressure and pulse rate of the patients at the baseline are similar to previous studies studying the severe preeclampsia. [9][10][11][12] No characteristic differences were observed among nifedipine, labetalol, and hydralazine groups in the present study.…”

“…10 In another study, patients in labetalol and nifedipine group experienced dizziness and/or headaches (24% vs 12%), palpitations (8% vs 4%), and foetal heart rate abnormalities (4% vs 8%). 9 These different findings on side effect might be due to the maximum dose used in both foregoing studies, which was 5 doses. 9,10 The strengths of this study include the multicentred randomized controlled study design, intensive monitoring, and repeated measurements up to seven times.…”

“…9 These different findings on side effect might be due to the maximum dose used in both foregoing studies, which was 5 doses. 9,10 The strengths of this study include the multicentred randomized controlled study design, intensive monitoring, and repeated measurements up to seven times. However, this study is limited by the fact that some of the hospitals only used single blinding because labetalol and hydralazine are new to some doctors.…”

“…The blood pressure targets to be achieved in patients with hypertensive emergencies in pregnancy differ from one guideline to another. 9 latest ACOG bulletin guidelines did not mention the target blood pressure and only mentioned the blood pressure threshold that clinicians should to achieve. This present study was the first to report the direct comparison of the effectiveness of nifedipine, labetalol, and hydralazine together.…”

Effectiveness of nifedipine, labetalol, and hydralazine as emergency antihypertension in severe preeclampsia: a randomized control trial

“…The blood pressure targets to be achieved in patients with hypertensive emergencies in pregnancy differ from one guideline to another. 9 The latest ACOG bulletin guidelines did not mention the target blood pressure and only mentioned the blood pressure threshold that clinicians should to achieve. This present study was the first to report the direct comparison of the effectiveness of nifedipine, labetalol, and hydralazine together.…”