Oral nifedipine therapy in the management of severe preeclampsia

Abstract

Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion. While hydralazine is administered intravenously and needs strict monitoring, nifedipine is more effective, is easy to administer orally, less demanding on hospital staff, convenient and more predictable.

Antihypertensive Medications in Management of Gestational Hypertension-Preeclampsia

“…1) and with use of additional antihypertensives (13% [0%-32%] for hydralazine vs. [5% {0%-24%}] nifedipine only; relative risk 2.13 [1.2-3.9]; 4 trials; chi square = 5.24, df = 3, P = 0.15; risk difference 0.08 [0.02-0.14]; 5 trials; chi square = 12.3, df = 4, P = 0.02), but there was still significant heterogeneity between trials within this subgroup. In the 3 trials with nifedipine or isradipine in which hydralazine was associated with more severe hypertension, the methods of allocation concealment were either clearly inadequate 33,38 or unstated, 40 other characteristics of the trials did not differ.…”

“…However, the 2 trials that reported HELLP syndrome as an outcome differed by more than could be expected by chance alone. 30,31,38 Comparing hydralazine with nifedipine, Kwawukume and Ghosh reported no raised liver enzymes, 38 but in a comparison of hydralazine and ketanserin, Bolte et al reported a significantly higher incidence (45% vs. 9%) of HELLP syndrome (using Sibai's definition in the hydralazine group). 30,31 In summary, hydralazine was associated with more persistent severe hypertension than nifedipine or isradipine, and more of the following outcomes when compared with all antihypertensives: maternal hypotension, placental abruption, cesarean section, and maternal oliguria.…”

“…Six RCTs clearly administered magnesium sulfate to all or a specified number of women. 27,33,38,43,53,56 Short-acting nifedipine (N = 5) or nicardipine 56 was administered; no trial report was described. In 3 RCTs, it was not clear that magnesium sulfate was administered.…”

“…In 2 trials, single doses were given, 35,41 and in 3 trials, patients were switched to oral antihypertensives when blood pressure had been stabilized. 33,37,38 Most commonly, hydralazine was compared with standard doses of other antihypertensives: nifedipine (8 trials), labetalol (5 trials), ketanserin (4 trials), urapidil (2 trials), epoprostenol (1 trial), or isradipine (1 trial with 3 publications).…”

Clinical trials in Ghana: evolution and current landscape

“…The earliest surgically-related trial reported in Ghana was a trial of intra-operative 5-fluorouracil as adjunct for reducing intraocular pressure in advanced glaucoma during trabeculectomy. 17 Early reproductive healthrelated trials reported during the period include a trial that compared oral nifedipine with hydralazine for controlling blood pressure in severe pre-eclampsia, 18 and a trial that evaluated Norplant as a contraceptive method. 19 The supplementation trials against nutritional disorders included studies that evaluated vitamin A supplementation against childhood malaria or morbidity.…”