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Hydralazine, labetalol, nifedipine produce similar efficacy in pregnant women with severe hypertension

Similar efficacy occurred in pregnant women who took hydralazine, labetalol, and nifedipine for their severe hypertension, according to findings recently published in the British Journal of Clinical Pharmacology.

“There is no clear consensus on the relative efficacy and safety of drugs used for treating severe hypertension in pregnancy. In fact, about a dozen of anti-hypertensive drugs have been explored for treating this disorder. This is mainly limited due to the scanty evidence from clinical trials,” Kannan Sridharan, DM, MBBS, and associate professor, department of pharmacology and therapeutics at the Arabian Gulf University in Bahrain told Healio Family Medicine.

“Hence, we carried out a network meta-analysis comparing all the drugs that have been tried for treating this disorder,” he added.

Researchers reviewed 97 articles that analyzed the efficacy of diazoxide, nicardipine, labetalol, various regimens of nifedipine and/or hydralazine for treatment of severe hypertension during pregnancy. Trials that looked at different doses, formulations and routes of the same drug or that assessed either IV magnesium sulphate/oral atenolol/oral alpha-methyldopa as the standalone anti-hypertensive drugs were not included.

The primary outcome was the number of pregnant women with hypertension reaching less than 140 mm Hg to 150 mm Hg for systolic BP and less than 90 mm Hg to 100 mm Hg for diastolic BP. Secondary outcomes included incidences of maternal tachycardia and palpitation.

Researchers performed a sensitivity analysis by not including trials with different BP criteria among their participants.

Sridharan and colleagues found no significant differences in the primary outcomes in any of the drugs, though nifedipine required fewer doses than hydralazine to meet the outcome. In addition, and when compared with hydralazine, glyceryl trinitrate was associated with fewer incidences of tachycardia and labetalol was associated with fewer incidences of palpitations.

“Physicians can consider using labetalol, hydralazine and nifedipine in patients with severe hypertension in pregnancy depending on the availability and affordability. However, further research is warranted in patients with co-existent preeclampsia,” Sridharan said in the interview. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.