A randomized, double-blind trial of oral nifedipine and intravenous labetalol in hypertensive emergencies of pregnancy

Vermillion, Stephen T.; Scardo, James A.; Newman, Roger B.; Chauhan, Suneet P.

doi:10.1016/s0002-9378(99)70314-5

Cited by 137 publications

(72 citation statements)

References 13 publications

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“…The Trial conducted by Vermillion et al (11) indicated that patients receiving oral Nifedipine more rapidly achieved therapeutic blood pressure goal in 25.0±13.6 minutes as compared with 43.6±25.4 minutes in women receiving intravenous labetalol (P=0.002). Vermillion drug regimen used higher oral nifedipine doses i.e.…”

Section: Discussionmentioning

confidence: 99%

Oral Nifedipine Versus Intravenous Labetalol for Control of Blood Pressure in Severe Preeclampsia

Kumari¹,

Saraswathi²,

Srilaxmi³

2016

jemds

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OBJECTIVETo compare the efficacy of oral nifedipine and IV Labetalol in acute blood pressure control in severe preeclampsia. METHODS200 women with blood pressure ≥160mmHg systolic and/or ≥110mmHg diastolic were randomized to receive oral nifedipine (10 mg tablet orally up to five doses) or IV labetalol in escalating doses of 20mg, 40mg, 80mg, 80mg and 80mg. They were administered drugs every 15 minutes until blood pressure was less than or equal to 150mm Hg systolic and 100mm Hg diastolic. Crossover treatment was administered if the initial treatment failed. The time required to reduce blood pressure to target value, the number of doses required and the adverse effects were measured. The statistical value of significance was taken at P<0.05. RESULTSThe patients who came in the inclusion criteria were treated with either nifedipine or labetalol based on their randomization number. It was found that oral nifedipine required 34.77±4.8 minutes whereas Inj. labetalol required 36.61±5.2 minutes to control blood pressure. The P value was 0.29.This indicates that the difference was not significant. Oral nifedipine required two doses each of 10mg to reduce blood pressure whereas Inj. labetalol required 3 doses, a total of 140mg to reduce blood pressure to the target level. The p-value calculated was 0.43 indicating the difference was not significant. Patients were also monitored for any side effects that may arise from the drugs. The adverse effects noted were dizziness, sweating, flushing, nausea, vomiting, palpitations, headache, shortness of breath and foetal tachycardia. Adverse effects observed were very few and of minor degree. There was no statistical difference in adverse effects noted in both the groups. CONCLUSIONSOral nifedipine and IV labetalol are similarly effective in the control of severe hypertension in pregnancy. KEYWORDSPreeclampsia Labetalol Nifedipine Hypertension, Pregnancy. HOW TO CITE THIS ARTICLE: INTRODUCTIONHypertensive disorders are one of the most common medical disorders complicating pregnancy and form part of a deadly triad along with haemorrhage and sepsis in contributing greatly to the maternal morbidity and mortality. (1) The incidence of hypertensive disorders ranges from 2-8% of all pregnancies and contribute to 9% of maternal mortality in Asia and 12% in India. (2,3,4) It has been estimated by the WHO that worldwide approximately 45,000 women will die each year from hypertensive disorders of pregnancy. The spectrum of hypertensive diseases that can complicate pregnancy are broad ranging from gestational hypertension, preeclampsia, chronic hypertension and chronic hypertension with superimposed pre-eclampsia. Preeclampsia, a multisystem disorder defined as hypertension of 140/90mmHg or more associated with significant proteinuria (≥30mg/dl in random urine samples or >300mg/24hrs urine or on dipstick 1+ or more proteinuria), usually develops after 20wks of gestation.

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Section: Discussionmentioning

confidence: 99%

Oral Nifedipine Versus Intravenous Labetalol for Control of Blood Pressure in Severe Preeclampsia

Kumari¹,

Saraswathi²,

Srilaxmi³

2016

jemds

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“…13) Furthermore, Eguchi et al reported that the incidence of intrauterine growth retardation and proportion of premature birth-related low-birthweight neonates were high in PIH patients. 14) In our study, 14 of the 20 severe PIH patients delivered low-birthweight neonates.…”

Section: Discussionmentioning

confidence: 99%

Umbilical cord blood concentrations of labetalol hydrochloride administered to patients with pregnancy induced hypertension, and subsequent neonatal findings

Uematsu

Kobayashi²,

Katsumoto³

et al. 2013

Hypertens Res Pregnancy

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Aim:We measured umbilical cord blood and maternal plasma concentrations of labetalol hydrochloride (labetalol) at delivery in women with pregnancy induced hypertension (PIH) who received labetalol treatment, and also investigated the influence of labetalol on neonatal findings. Methods: We surveyed background, neonatal findings, and health checkups after birth among PIH patients who received labetalol. Umbilical cord blood was collected within 15 min after delivery and venous blood within 2 h. Umbilical cord blood and maternal plasma concentrations of labetalol were measured using liquid chromatographytandem mass spectrometry. Results: PIH was evaluated as severe hypertension in 20 patients and mild hypertension in 9 according to the Guidelines for the Management of PIH. Umbilical cord blood concentrations of labetalol were 17.2 ± 11.4 ng /ml in the 150 mg / day group (n = 22) and 32.8 ± 11.6 ng /ml in the 300 mg /day group (n = 7). Mean maternal plasma concentrations of labetalol in the 150 mg /day and 300 mg /day groups were 29.2 ± 21.0 ng /ml and 49.3 ± 12.6 ng /ml, respectively. The 300 mg /day group also included 2 low-birthweight neonates, whose Apgar scores were 5 after 1 min but returned to normal values after 5 min. There were no abnormalities in Apgar score or umbilical cord blood pH in any other neonates and no abnormal findings at neonatal checkups. Patients who continued drug therapy after delivery even performed breast feeding. Conclusions: There was some correlation between labetalol concentrations in umbilical cord blood and in maternal plasma (r = 0.688), with the former corresponding to 60% to 70% of the latter. Hypertension Research In Pregnancy

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“…Compared with oral nifedipine or parenteral nicardipine, parenteral labetalol appears to be similarly effective for BP control [322][323][324].…”

Section: Antihypertensive Therapymentioning

confidence: 99%

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Magee

Pels

Helewa

et al. 2008

Journal of Obstetrics and Gynaecology Canada

421

218

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A randomized, double-blind trial of oral nifedipine and intravenous labetalol in hypertensive emergencies of pregnancy

Cited by 137 publications

References 13 publications

Oral Nifedipine Versus Intravenous Labetalol for Control of Blood Pressure in Severe Preeclampsia

Oral Nifedipine Versus Intravenous Labetalol for Control of Blood Pressure in Severe Preeclampsia

Umbilical cord blood concentrations of labetalol hydrochloride administered to patients with pregnancy induced hypertension, and subsequent neonatal findings

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

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