Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis

Awaludin, Adila; Rahayu, Cherry; Daud, Nur Aizati Athirah; Zakiyah, Neily

doi:10.3390/healthcare10020325

Cited by 23 publications

(8 citation statements)

References 46 publications

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“…The specific pharmaceutical to treat hypertension during pregnancy should be carefully selected. Efficacy of antihypertensive pharmaceuticals was assessed by the risk of persistent severe hypertension ( Awaludin et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis

et al. 2023

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Aims: To evaluate the efficacy of different pharmacologic treatment for severe hypertension during pregnancy.Methods: Two reviewers searched Ovid MEDLINE, Ovid EMbase, and the Cochrane Library for randomized clinical trials from the establishment of the database to 15 July 2021 that were eligible for inclusion and analyzed the pharmaceuticals used for severe hypertension in pregnancy.Results: 29 relevant trials with 2,521 participants were involved. Compared with diazoxide in rate of achieving target blood pressure, other pharmaceuticals, including epoprostenol (RR:1.58, 95%CI:1.01–2.47), hydralazine\dihydralazine (RR:1.57, 95%CI:1.07–2.31), ketanserin (RR:1.67, 95%CI:1.09–2.55), labetalol (RR:1.54, 95%CI:1.04–2.28), nifedipine (RR:1.54, 95%CI:1.04–2.29), and urapidil (RR:1.57, 95%CI:1.00–2.47), were statistically significant in the rate of achieving target blood pressure. According to the SUCRA, diazoxide showed the best therapeutic effect, followed by nicardipine, nifedipine, labetalol, and nitroglycerine. The three pharmaceuticals with the worst therapeutic effect were ketanserin, hydralazine, and urapidil. It is worth noting that the high ranking of the top two pharmaceuticals, including diazoxide and nicardipine, comes from extremely low sample sizes. Other outcomes were reported in the main text.Conclusion: This comprehensive network meta-analysis demonstrated that the nifedipine should be recommended as a strategy for blood pressure management in pregnant women with severe hypertension. Moreover, the conventional pharmaceuticals, including labetalol and hydralazine, showed limited efficacy. However, it was important to note that the instability of hydralazine reducing blood pressure and the high benefit of labetalol with high dosages intakes should also be of concern to clinicians.

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Section: Discussionmentioning

confidence: 99%

Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis

et al. 2023

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“…Severe preeclampsia is one of the conditions whereby guidelines recommend a more aggressive BP reduction to less than 140 mmHg SBP within 1 h of diagnosis [1]. A recent meta-analysis interestingly found that rapid-acting oral nifedipine resulted in the most sustained BP reduction; however, all the traditional agents: labetalol, nicardipine, and urapidil, were equally effective at the time to BP control [47 ▪ ].…”

Section: Other Conditionsmentioning

confidence: 99%

Hypertensive crisis: diagnosis, presentation, and treatment

Stewart¹

2023

Current Opinion in Cardiology

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Purpose of reviewHypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.Recent findingsNovel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130–140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.SummaryHTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.

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“…Studi meta-analisis menunjukkan penggunaan oral nifedipin pada pasien preeklamsia memberikan keberhasilan terapi yang lebih tinggi dibanding antihipertensi lainnya [17]. Studi lainnya menunjukkan bahwa penggunaan kombinasi antihipertensi tidak memberikan luaran neonatal yang lebih baik dibanding penggunaan antihipertensi tunggal [18,19].…”

Section: Pendahuluanunclassified

“…Metildopa bekerja di sistem saraf pusat melalui mekanisme agonis reseptor alfa dimana obat ini merupakan obat antihipertensi paling aman untuk ibu hamil [13]. Berdasarkan studi meta-analisis diketahui penggunaan metildopa selama kehamilan relatif lebih efektif dalam mengontrol tekanan darah dan tingkat efek samping yang lebih rendah dibandingkan dengan nifedipin [17].…”

Section: Hasil Dan Pembahasanunclassified

Hubungan Penggunaan Kombinasi Antihipertensi Dengan Luaran Neonatal pada Pasien Preeklamsia

Awaludin,

Nurzaman,

Annisa

et al. 2023

MPI

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Hipertensi selama kehamilan meningkatkan risiko terjadinya komplikasi maternal. Preeklamsia merupakan komplikasi yang umumnya paling sering terjadi selama masa kehamilan. Komplikasi pada masa kehamilan berdampak pada pemburukan luaran neonatal. Manajemen terapi yang tepat pada pasien preeklamsia dihubungkan dengan luaran neonatal yang lebih baik. Tujuan dari penelitian ini adalah untuk menggambarkan penggunaan antihipertensi pada pasien preeklamsia pada fasilitas kesehatan sekunder di Tasikmalaya dan menilai hubungan antara pemberian kombinasi antihipertensi dengan luaran neonatal yang dihasilkan. Penelitian ini merupakan studi multisenter menggunakan desain potong lintang secara retrospektif dari Juli 2018-Juni 2023. Selama periode penelitian didapat 88 pasien bersalin dengan diagnosa preeklamsia yang memenuhi kriteria inklusi dan eksklusi. Metildopa, nifedipin, dan amlodipin merupakan antihipertensi yang digunakan pada populasi studi dimana kombinasi antihipertensi yang digunakan diantaranya adalah kombinasi amlodipin dengan metildopa atau nifedipin dengan metildopa. Pada populasi studi, metildopa merupakan antihipertensi yang paling sering digunakan. Hasil analisis menunjukkan bahwa tidak terdapat hubungan antara penggunaan kombinasi antihipertensi dengan luaran neonatal. Namun, pasien dengan terapi kombinasi antihipertensi memiliki prevalensi lebih tinggi untuk luaran neonatal yang tidak diinginkan. Hypertension during pregnancy increases the risk of maternal complications. Preeclampsia is the most common complication that appears during pregnancy. Complications during pregnancy had a poor impact on neonatal outcomes. Appropriate therapy management in preeclampsia patients is suggested to improve neonatal outcomes. This study aimed to describe the use of antihypertensives in preeclampsia in Tasikmalaya and assess the association between the combination of antihypertensives with neonatal outcomes. This was a multi-center study with a cross-sectional design retrospectively from July 2018 to June 2023. In the study period, 88 maternal deliveries with preeclampsia met the inclusion and exclusion criteria. Methyldopa, nifedipine, and amlodipine were used in the study population whereas amlodipine with metildopa or nifedipine with metildopa were the option of antihypertensive combination. In the study population, metildopa was the most frequently used antihypertensive. The analysis results showed there was no association between using a combination of antihypertensives and neonatal outcomes. However, patients treated with combination antihypertensive had a higher prevalence of unfavorable neonatal outcomes.

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Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis

Cited by 23 publications

References 46 publications

Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis

Pharmaceutical administration for severe hypertension during pregnancy: Network meta-analysis

Hypertensive crisis: diagnosis, presentation, and treatment

Hubungan Penggunaan Kombinasi Antihipertensi Dengan Luaran Neonatal pada Pasien Preeklamsia

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