Feb
2014
Hypertension is common during pregnancy, but the choice of standard
first-line therapy remains controversial since there are concerns over
hydralazine and no clear evidence of the superiority of nifedipine or
labetalol. However, a recent head-to-head comparison of the latter two agents
has shown that nifedipine appears to exert a superior effect.
Between October 2012 and April 2013,
researchers at a tertiary care teaching and referral hospital in India
conducted a double-blind trial involving 60 women aged 18–45 years who were at
24 weeks’ gestation or greater and who had sustained severe hypertension
(defined as systolic blood pressure [BP] ≥ 160 mm Hg or diastolic BP ≥ 110 mm
Hg measured on two separate occasions at least 30 minutes apart). The women were
randomly assigned to receive up to five doses of oral nifedipine 10 mg and an
intravenous (IV) saline injection (n = 30) or up to five doses of IV labetalol
20 mg, 40 mg, or 80 mg and a placebo tablet (n = 30) every 20 minutes until the
target BP of 150 mm Hg systolic and 100 mm Hg diastolic or lower was met.
Labetalol was administered via three 20-mL syringes, each of which contained 5
mg/mL of the agent. A total of 4 mL was administered initially, followed by 8
mL after 20 minutes if the target BP was not met; if there was still no
improvement after another 20 minutes, then 16 mL was administered. Two further
16-mL injections could be administered if needed. The crossover treatment was
administered if the initial treatment failed.
The median time to achieve the target BP
was 40 minutes (interquartile range [IQR], 20–60 minutes) with nifedipine
compared with 60 minutes (IQR, 40–85 minutes) with labetalol (P = 0.008).
Moreover, fewer nifedipine doses were required (median, 2 [IQR, 1–3] nifedipine
vs 3 [IQR, 2–4.25] labetalol; P = 0.008). No serious adverse maternal or
perinatal side effects were observed in either group.
Shekhar S et al. Oral nifedipine or
intravenous labetalol for hyperintensive emergency in pregnancy: a randomized
controlled trial. Obstet Gynecol 2013;122(5):1057–1063.
(Hvtbmt sưu tầm,
Nguồn: http://pub.mims.com/)
