Oral Nifedipine versus Intravenous Labetalol in Hypertensive Emergencies of Pregnancy- A Randomised Trial

Abstract

BACKGROUNDHypertensive disorders during pregnancy are the most significant and unresolved problems in obstetrics. Antihypertensive treatment is indicated for all pregnant women with blood pressure greater than or equal to 160 mmHg systolic or 110 mmHg diastolic. This degree of hypertension requires urgent assessment and management. In this study, we compared the effectiveness of oral nifedipine and intravenous labetalol in the control of hypertensive emergencies of pregnancy. METHODSIn this open-label randomised trial, 60 pregnant women with ≥28 weeks of gestation with sustained severe hypertension (systolic blood pressure of ≥160 or/and diastolic blood pressure ≥110 mmHg) were allocated to two groups in a randomised manner. One group (n=30) received intravenous labetalol and the other group (n=30) received oral nifedipine according to National Health Mission, Government of India protocol. Injection labetalol was given in repeated doses (20, 40, 80, 80, and 80) every 10 minutes and oral nifedipine capsule was repeated in 10 mg doses at 30 minutes interval until the target BP of ≤ 150/100 mmHg was achieved. RESULTSThe result of this study showed that after 30 minutes, more patients in the nifedipine group (66.6%) achieved the target blood pressure as compared to the labetalol group (46.6%). The mean time taken to achieve this target blood pressure was 30.6 ± 7.8 minutes versus 34 ± 7.7 minutes for nifedipine and labetalol group respectively (p=0.09). CONCLUSIONSBoth oral nifedipine and intravenous labetalol regimens are equally effective and well tolerated when used for rapid control of blood pressure in severe hypertension of pregnancy. Nifedipine may be preferred due to lesser repetition of doses, simple and flat dosage pattern, and ease of oral administration, low cost and wide availability.