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

Abstract

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.

Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomized controlled trial

“…Dhali B et al, in their study recorded similar percentage of eclampsia; 6% and 2% respectively. 13 Placental abruption was found in 1 (2.5%) patient in each group, similar to the study conducted by Sujit et al In the present study, mean (SD) birth weight of babies in both the groups were comparable, similar to the study Kumari RV et al 20 There was only one stillbirth (placental abruption). Neonatal death was 5% in Group A and 2.5% in Group B.…”

Oral Nifedipine and Intravenous Labetalol for Hypertensive Emergencies in Pregnancy : A Comparative Study

“…It is a pregnancy category C drug and has the advantage of being cost effective, rapid onset of action, long duration of action, oral bioavailability, easier to store and infrequent side effects. 6 Sublingual route is not recommended since it produces a rapid fall of the blood pressure. However it is known to cause reflex tachycardia and headache.…”