Abstract
Vitamin D (VD) has exhibited immunomodulatory role in the pathogenesis of preeclampsia. We hypothesize VD potentiate nifedipine treatment for preeclampsia by shortened the time to control blood pressure and prolong time before subsequent hypertensive crisis. We conduct a randomized trial of 683 primigravid women with preeclampsia, who were assigned to different treatment groups, either nifedipine+placebo or nifedipine+VD orally, by random after screening. Primary endpoints include time to control hypertension and time before another hypertensive crisis. Maternal adverse effects including nausea, vomiting, chest pain, mild headache, dizziness, maternal tachycardia, hypotension or shortness of breath, and neonatal parameters including birth weight and Apgar scores, as well as the minimum number of dosages needed to control hypertension were defined as secondary endpoints. Serum levels of cytokines tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were also examined. There was a marked reduction of the time required to control hypertension and a significant lengthening (p = 0.013) of the time before a new hypertensive crisis in participants received nifedipine+VD treatments (41.8 ± 18.3 min), in comparison with the nifedipine+placebo controls (61.1 ± 15.9 min). In women treated with nifedipine+VD, the minimum number of dosages needed to control hypertension was also lower. With regard to adverse effects, no statistical difference was observed between the two treatment groups. Moreover, treatment with VD increased IL-10 and reduced TNF-α serum levels. VD possesses the potential of serving as a safe and effective adjuvant to oral nifedipine in treating women with preeclampsia against hypertension, possibly through the upregulation of IL-10 and the downregulation of TNF-α.
Highlights
Preeclampsia, which uniquely manifests during pregnancy after 20 weeks post-gestation, is a severe disorder affecting various systems (American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy, 2013)
From January 2011 to December 2016, 683 primigravid women with preeclampsia and singleton pregnancy were enrolled in the current trial, among which 81 participants were later excluded
Based on the reported function of Vitamin D (VD) against hypertension, we included VD in our clinical trial among women with preeclampsia, to examine whether VD could synergize with oral nifedipine to alleviate hypertension in preeclampsia
Summary
Preeclampsia, which uniquely manifests during pregnancy after 20 weeks post-gestation, is a severe disorder affecting various systems (American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy, 2013). It is essential to monitor and control the blood pressure of patients in the clinical treatment of preeclampsia (Magee et al, 2008; Abalos et al, 2014), in which anti-hypertensive drugs are widely used (Belfort et al, 1990). Nifedipine, a blocker of Ca2+ channels (Fenakel et al, 1991), is commonly prescribed to preeclampsia patients as a first line anti-hypertensive drug (Fenakel et al, 1991; Magee et al, 2008; Duley et al, 2013). Nifedipine improves renal blood flow, thereby decreasing vascular resistance. It yields increased urine output by suppressing anti-diuretic hormones. Treatment with nifedipine during the third trimester can effectively alleviate high blood pressure without any serious neonatal or maternal adverse effects (Childress and Katz, 1994)
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