A Controlled Trial of Hypotensive Agents in Hypertension in Pregnancy

Leather, Hugh; Humphreys, D M; Baker, Patricia; Chadd, M. A.

doi:10.1016/s0140-6736(68)90650-8

Cited by 110 publications

(4 citation statements)

References 6 publications

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“…Of the 23 articles that were excluded, 14 studies included a mixed population of gestational and chronic hypertension and did not report outcomes separately, 6 studies included only gestational hypertension, 1 article reported no additional outcomes for a trial already included in the meta‐analysis (Table ) . In addition, Leather and colleagues reported a randomized controlled trial in 1968 that recruited 47 chronic hypertensive participants randomized to bendroflumethiazide and methyldopa versus no treatment.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, Leather and colleagues reported a randomized controlled trial in 1968 that recruited 47 chronic hypertensive participants randomized to bendroflumethiazide and methyldopa versus no treatment. This article could not be included due to inadequate reporting of the statistical information relating to the outcomes, prohibiting inclusion of the data in the meta‐analysis . Leather and colleagues concluded that the treatment of “early hypertension” (present before 20 weeks’ gestation) resulted in a longer pregnancy, increased birth weight and reduced perinatal mortality.…”

Section: Resultsmentioning

confidence: 99%

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Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Webster

Conti‐Ramsden

Seed

et al. 2017

JAHA

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BackgroundChronic hypertension complicates around 3% of all pregnancies. There is evidence that treating severe hypertension reduces maternal morbidity. This study aimed to systematically review randomized controlled trials of antihypertensive agents treating chronic hypertension in pregnancy to determine the effect of this intervention.Methods and ResultsMedline (via OVID), Embase (via OVID) and the Cochrane Trials Register were searched from their earliest entries until November 30, 2016. All randomized controlled trials evaluating antihypertensive treatments for chronic hypertension in pregnancy were included. Data were extracted and analyzed in Stata (version 14.1). Fifteen randomized controlled trials (1166 women) were identified for meta‐analysis. A clinically important reduction in the incidence of severe hypertension was seen with antihypertensive treatment versus no antihypertensive treatment/placebo (5 studies, 446 women; risk ratio 0.33, 95%CI 0.19‐0.56; I2 0.0%). There was no difference in the incidence of superimposed pre‐eclampsia (7 studies, 727 women; risk ratio 0.74, 95%CI 0.49‐1.11; I2 28.1%), stillbirth/neonatal death (4 studies, 667 women; risk ratio 0.37, 95%CI 0.11‐1.26; I2 0.0%), birth weight (7 studies, 802 women; weighted mean difference −60 g, 95%CI −200 to 80 g; I2 0.0%), or small for gestational age (4 studies, 369 women; risk ratio 1.01, 95%CI 0.53‐1.94; I2 0.0%) with antihypertensive treatment versus no treatment/placebo.ConclusionsAntihypertensive treatment reduces the risk of severe hypertension in pregnant women with chronic hypertension. A considerable paucity of data exists to guide choice of antihypertensive agent. Adequately powered head‐to‐head randomized controlled trials of commonly used antihypertensive agents are required to inform prescribing.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Webster

Conti‐Ramsden

Seed

et al. 2017

JAHA

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“…2 In untreated severely hypertensive women intrauterine growth retardation is common3 and the risk of fetal loss is high at all stages of gestation.4 Antihypertensive treatment reduces the incidence of sudden rises in blood pressure and improves the perinatal outcome. 6 The antihypertensive agent most often studied in pregnancy, methyldopa, though having no harmful effects on the fetus,8 8has not been shown actively to improve fetal growth or wellbeing except for a possible reduction in the incidence of midtrimester abortion,8 a risk that is increased in women with severe hypertension. "…”

Section: Introductionmentioning

confidence: 99%

Randomised comparison of methyldopa and oxprenolol for treatment of hypertension in pregnancy.

Gallery¹,

Dm²,

Hunyor³

et al. 1979

BMJ

149

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Summary and conclusionsFifty-three pregnant women with moderately severe hypertension were randomly allocated to treatment with methyldopa or oxprenolol. There were no significant differences between the groups in age, height, weight, parity, or To examine the effects of antihypertensive treatment more closely and to evaluate alternative forms of treatment we conducted a randomised comparison of methyldopa and a non-selective beta-adrenoceptor-blocking drug, oxprenolol.

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“…17–25 Seventy-two trials were included—N=61 trials from the prior Cochrane review 1 and N=11 new trials, N=8 previously excluded from the Cochrane review, because they compared antihypertensives within the same drug class or N=3 because they were trials of differential BP control. 26–96 See Appendix in the Supplemental Material for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram (Figure S1) and checklist (Tables S3 and S4).…”

Section: Resultsmentioning

confidence: 99%

Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses

et al. 2022

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Background: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. Methods: Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/ ; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. Results: Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54–0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30–0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44–0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41–0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. Conclusions: In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care.

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A Controlled Trial of Hypotensive Agents in Hypertension in Pregnancy

Cited by 110 publications

References 6 publications

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Impact of Antihypertensive Treatment on Maternal and Perinatal Outcomes in Pregnancy Complicated by Chronic Hypertension: A Systematic Review and Meta‐Analysis

Randomised comparison of methyldopa and oxprenolol for treatment of hypertension in pregnancy.

Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses

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