FIRST-LINE ANTIHYPERTENSIVE TREATMENT FOR SEVERE HYPERTENSION IN PREGNANCY: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Abstract

Objectives Current clinical practice guidelines recommend IV hydralazine, IV labetalol, and oral nifedipine as first-line treatments for severe hypertension in pregnancy. Our goal was to compare safety and efficacy of hydralazine, labetalol, and nifedipine for the treatment of severe hypertension in pregnancy. Methods A systematic search of Medline, Embase, and Cochrane up to May 31, 2018 was conducted. Randomized controlled trials in pregnancy comparing a first-line antihypertensive agents to. Screening, data abstraction, and quality assessment were done by two independent reviewers. To estimate relative effects, a Bayesian network meta-analysis with vague priors was conducted using both a fixed and random effects model. Results A total of 18 RCTs comprising a total of 1669 women met our selection criteria. The random effects model found no significant difference for treatment success between and of the three treatment comparisons although there was a trend favouring nifedipine over labetalol and hydralazine (OR 2.56 [95% CrI 0.85-8.12] and OR 2.90 [95% CrI 0.97-8.31]). This trend was found to be significant in the fixed effects model with nifedipine having significantly higher odds for treatment success compared to labetalol (OR 2.36 [95% CrI 1.08-5.52]) and hydralazine (OR 3.03 [95% CrI 1.45-6.62]). The analysis showed no significant difference in caesarean delivery nor in composite maternal side effects between any of the treatment comparisons. Conclusions This study provides evidence favouring oral nifedipine over labetalol and hydralazine, for the management of severe hypertension in pregnancy. A core outcome set for hypertension in pregnancy would aid in improving the quality of future meta-analyses.