Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta‐analysis

Abstract

Background Oral nifedipine is recommended along with labetalol and hydralazine for treatment of severe hypertension during pregnancy by most authorities. Although nifedipine is cheap and easily administered, the usage pattern among health care providers suggests a strong preference for labetalol despite lack of evidence for the same.Objectives To determine the efficacy and safety of oral nifedipine for treatment of severe hypertension of pregnancy compared with intravenous labetalol. Selection criteria We included all RCTs that compared intravenous labetalol with oral nifedipine for treatment of severe hypertension during pregnancy, addressing relevant efficacy and safety outcomes.Data collection and analysis Eligible studies were reviewed, and data were extracted onto a standard form. We used Cochrane review manager software for quantitative analysis. Data were analysed using a fixed effect model. Main resultsThe pooled analysis of seven trials (four from developing countries) consisting of 363 woman-infant pairs showed that oral nifedipine was associated with less risk of persistent hypertension (RR 0.42, 95% CI 0.18-0.96) and reported maternal side effects (RR 0.57, 95% CI 0.35-0.94). However, on sensitivity analysis the outcome 'persistent hypertension' was no longer significant. Other outcomes did not reach statistical significance.Conclusion Oral nifedipine is as efficacious and safe as intravenous labetalol and may have an edge in low resource settings.Keywords Labetalol, meta-analysis nifedipine, severe hypertension during pregnancy, severe pre-eclampsia.Tweetable abstract Although studies to date are few in number and small, nifedipine shows promise for severe hypertension in pregnancy.

Oral nifedipine vs. intravenous labetalol for treatment of pregnancy-induced severe pre-eclampsia

“…We did not observe any serious adverse maternal or neonatal effects associated with either of the trial medications. These findings are consistent with previous studies that oral nifedipine is as efficacious and safe as intravenous labetalol in control of severe hypertension during pregnancy . However, Shekhar et al .…”

“…However, Shekhar et al . 's systematic review also showed that nifedipine was associated with fewer maternal adverse effects of nausea, vomiting, headache or palpitations. In addition, labetalol was associated with more stillbirths [18/157 (labetalol) vs. 13/166 (nifedipine)] and more neonatal deaths [10/105 (labetalol) vs. 3/116 (nifedipine)].…”

Lipid profile and cytokines in hypertension of pregnancy: A comparison of preeclampsia therapies

“…Nifedipine, a clinically useful L‐type voltage‐gated calcium channel blocker, has the advantage of 45% to 70% oral bioavailability and 4‐hour half‐life, while labetalol has combined adrenoceptor blocking effects along with the availability of intravenous formulation for use in hypertensive emergencies. Our study demonstrates that both oral nifedipine and intravenous labetalol were equally effective in the management of SPE with respect to time taken to achieve target BP, which is in agreement with previous reports that oral nifedipine and intravenous labetalol treatments are similarly effective in controlling severe hypertension in pregnancy . Moreover, in the present study, the adverse effects of both nifedipine and labetalol were similar, which is consistent with observations of previous reports .…”

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

“…Interestingly, the World Health Organization (WHO) has listed only intravenous hydralazine in its latest essential drugs list (EDL) for treating severe hypertension in pregnancy . Although cost‐effectiveness data for hydralazine and nifedipine is not available, because nifedipine can be administered orally, available as the generic preparation with a similar efficacy and safety profile confirmed in the present review and in previous reviews , the WHO may consider including nifedipine in the EDL for primary health care. Moreover, we observed that nifedipine performs better than hydralazine when the target BP is less than 160/110 mmHg.…”