Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalised patients: A systematic review

Abstract

Background: Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilised with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalised patients with non-emergent, asymptomatic HTN. Methods:The PRISMA guidelines were utilised to structure the systematic review.A search strategy composed of drug-, inpatient-and HTN-related terms was conducted utilising PubMed, Embase and Scopus databases through May 2020.Full-text, English-language articles describing IV labetalol and/or hydralazine use for non-emergent HTN in an inpatient setting that focused on clinical outcomes (ie vitals, adverse effects, healthcare utilisation) were included. Identified studies were screened/extracted using DistillerSR by two reviewers at each stage, and studies were evaluated qualitatively for the presence of bias.Results: From 3362 records identified in the search, a final set of 10 articles were identified. Four studies focused on labetalol (40%), five studies on hydralazine and labetalol (50%), and one study on hydralazine (10%). The included studies presented a variety of outcomes, but several trends were identified, including reduction in average blood pressure in eight (80%) studies, a risk of adverse effects in six (60%) and increased length of stay in one (10%). Discussion:The studies identified in this review raise concerns regarding the safety of IV hydralazine and labetalol in non-emergent HTN. Despite relatively broad clinical experience with these drugs, experimental investigations regarding their utility are recommended.

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

“…Another study’s ( Aali and Nejad, 2002 ) data analysis indicated that relative to hydralazine, significantly fewer pharmaceutical administrations of nifedipine were required; our results were consistent with this. However, the dose-response of hydralazine was largely unpredictable and might eventually led to an unpredicted response to blood pressure ( Cawoski et al, 2021 ). Another experiment showed that ( Shepherd et al, 1984 ) within the therapeutic dosages range for proper using of the pharmaceutical with the increased of the dosages of hydralazine, maternal blood pressure was found to decrease much more than expected.…”

“…One other study ( Fenakel et al, 1991 ) also arrived at the same results, but they believed that effect of nifedipine was more predictable that of hydralazine. The possible reason is that the dose-response of hydralazine was largely unpredictable and may ultimately lead to an unpredicted response to blood pressure ( Cawoski et al, 2021 ). In addition, the pharmaceutical had long been used for rapid control of severe hypertension during pregnancy ( Chera-Aree et al, 2020 ).…”