Oral Nifedipine or Intravenous Labetalol for Hypertensive Emergency in Pregnancy

Shekhar, Shashank; Sharma, Chanderdeep; Thakur, Sita; Verma, Suresh

doi:10.1097/aog.0b013e3182a9ea68

Cited by 79 publications

(57 citation statements)

References 14 publications

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“…Any disagreement was resolved by consensus. Assessment of methodological quality and data extraction of one study 18 was done by NG and RK because one of the authors of this review (SS) is also the author of that study. Risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.…”

Section: Study Quality Assessmentmentioning

confidence: 99%

“…14,[16][17][18][19][20][21] Supporting Information Table S1 shows selected characteristics of included trials. Three trials 14,16,20 enrolled women with pre-existing hypertension and pregnancy-induced hypertension with or without proteinuria and two trials 18,19 enrolled only pregnancyinduced hypertension with or without proteinuria. Information regarding the formulation of nifedipine was available for five trials.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Both intravenous labetalol and nifedipine have been compared directly with many other antihypertensive agents for hypertensive crises during pregnancy; however, their direct comparison with each other is limited to a very few RCTs. [14][15][16][17][18][19][20][21] Most of these trials suffer from small sample size or methodological shortcomings, thus precluding any definite conclusion regarding comparative efficacy and safety of these two drugs. This comparison has also been attempted in the domain of a systematic review by Cochrane collaboration; however, the results were inconclusive.…”

Section: Introductionmentioning

confidence: 99%

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Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta‐analysis

Shekhar

Gupta

Kirubakaran

et al. 2015

BJOG

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Background Oral nifedipine is recommended along with labetalol and hydralazine for treatment of severe hypertension during pregnancy by most authorities. Although nifedipine is cheap and easily administered, the usage pattern among health care providers suggests a strong preference for labetalol despite lack of evidence for the same.Objectives To determine the efficacy and safety of oral nifedipine for treatment of severe hypertension of pregnancy compared with intravenous labetalol. Selection criteria We included all RCTs that compared intravenous labetalol with oral nifedipine for treatment of severe hypertension during pregnancy, addressing relevant efficacy and safety outcomes.Data collection and analysis Eligible studies were reviewed, and data were extracted onto a standard form. We used Cochrane review manager software for quantitative analysis. Data were analysed using a fixed effect model. Main resultsThe pooled analysis of seven trials (four from developing countries) consisting of 363 woman-infant pairs showed that oral nifedipine was associated with less risk of persistent hypertension (RR 0.42, 95% CI 0.18-0.96) and reported maternal side effects (RR 0.57, 95% CI 0.35-0.94). However, on sensitivity analysis the outcome 'persistent hypertension' was no longer significant. Other outcomes did not reach statistical significance.Conclusion Oral nifedipine is as efficacious and safe as intravenous labetalol and may have an edge in low resource settings.Keywords Labetalol, meta-analysis nifedipine, severe hypertension during pregnancy, severe pre-eclampsia.Tweetable abstract Although studies to date are few in number and small, nifedipine shows promise for severe hypertension in pregnancy.

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Section: Study Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta‐analysis

Shekhar

Gupta

Kirubakaran

et al. 2015

BJOG

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“…Four randomized controlled trials (RCTs) [7][8][9][10] including 226 pregnant women and 34 postpartum women within 48 h of delivery were identified. Table 1 shows the characteristics of the included trials.…”

mentioning

confidence: 99%

Oral nifedipine versus intravenous labetalol for the treatment of severe hypertension in pregnancy

Shi¹,

Leng²,

Yao³

et al. 2015

International Journal of Cardiology

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“…Although, relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the evidence available suggests that oral nifedipine also may be considered as a first-line therapy (12)(13)(14)(15). Although, relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the evidence available suggests that oral nifedipine also may be considered as a first-line therapy (12)(13)(14)(15).…”

Section: Recommendationsmentioning

confidence: 99%

Committee Opinion No. 623

2015

Obstetrics &Amp; Gynecology

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Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur in pregnant women or women in the postpartum period. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Once the hypertensive emergency is treated, a complete and detailed evaluation of maternal and fetal well-being is needed with consideration of, among many issues, the need for subsequent pharmacotherapy and the appropriate timing of delivery.

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Oral Nifedipine or Intravenous Labetalol for Hypertensive Emergency in Pregnancy

Abstract: I.

Cited by 79 publications

References 14 publications

Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta‐analysis

Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta‐analysis

Oral nifedipine versus intravenous labetalol for the treatment of severe hypertension in pregnancy

Committee Opinion No. 623

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