Hypertensive Emergencies In Pregnancy Research Articles

A Randomized Trial of Intravenous Labetalol Versus Oral Nifedipine in Acute Blood Pressure Control in Hypertensive Emergencies of Pregnancy

Background: Hypertension in pregnancy, called a disease of degree is more of a sign than a disease by itself. Hypertensive disorders of pregnancy, including chronic hypertension, with or without superimposed pre-eclampsia/eclampsia, gestational hypertension, HELLP syndrome, pre-eclampsia with or without severe features or eclampsia present a significant risk of morbidity to both mother and fetus. Effective pharmacologic therapy modifies the course of the disease. The effective use of anti-hypertensive therapy should be based on well designed controlled clinical trials and the experience of the clinician with the drugs. Hypertensive disorders complicate 5-10% of all pregnancies worldwide. 1 Dangerous hypertension is a harbinger of cerebrovascular accidents, eclampsia, hypertensive encephalopathy and other end organ damage with a poor perinatal outcome. 2 Methods: This prospective randomized double blind comparative clinical trial with randomization done using computer generated numbers study was carried out in 100 cases being brought in OBG department of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. The pregnant women were randomized with computer generated numbers into two groups to receive either oral nifedipine or intermittent intravenous labetalol injections. Results: There is no significant difference in the parity of both the groups. Majority of the patients constituting 80% of group A and 58% of group B were primigravida. 69% enrolled in the study were primigravida. There is a higher incidence of pre-eclampsia in the first pregnancy. The majority of the patients had gestational age of 34 to 36 weeks constituting 48% on the whole with 50% and 46% respectively in group A and B. The recruited patients did not significantly differ in gestational age

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

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

Diagnosis and treatment of hypertensive disorders of pregnancy: a narrative review

The paper overviews classification, diagnosis and treatment of hypertensive disorders of pregnancy and early postpartum period (chronic hypertension (HTN), gestational HTN, pre-eclampsia) provided by different societies of cardiology and obstetrics and gynecology. The definition of pre-eclampsia offered by the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018 and supported by the International Federation of Gynecology and Obstetrics (FIGO) in 2019, its screening and prevention are considered. All treatment options of moderate and severe HTN in pregnancy are reviewed. A new US Food and Drug Administration (FDA) classification system of drug therapy for pregnancy and lactation Pregnancy and Lactation Labelling Rule (PLLR, 2015) is presented. Treatment goals of HTN and blood pressure (BP) thresholds in pregnancy as well as risk factors, causes, clinical presentation, diagnostic workup and management of hypertensive emergencies in pregnancy are provided. We discuss the evidence of BP ≥ 130/80 mmHg as a factor of high maternal and neonatal risks proposed by the American College of Cardiology/American Heart Association (2017) as the HTN criteria in pregnancy.

Improving compliance with guidelines for hypertensive disorders of pregnancy through an electronic health record alert: A retrospective chart review.

Improve appropriate and timely administration of rapid acting antihypertensive medication for the management of hypertensive emergency in pregnancy with utilization of an automated electronic health record (EHR) alert in an academic birthplace. An automated alert was incorporated into an existing EHR that notified providers of a documented severe range blood pressure, defined as systolic blood pressure (SBP)≥160mmHg or diastolic blood pressure (DBP)≥110mmHg. Retrospective chart review was utilized to evaluate appropriate intervention before and after implementation of the alert (referred to as pre-implementation and post-implementation cohorts). The primary outcome was appropriate administration of rapid-acting antihypertensive medication for the management of hypertensive emergency. Secondary outcomes included: appropriate administration of intravenous (IV) magnesium sulfate for seizure prophylaxis, initiation of oral antihypertensive medication postpartum, and appropriate timing of follow up for blood pressure evaluation following discharge. Of 98 patients identified as having hypertensive emergency in the pre-implementation cohort, 34 (35%) received treatment with a rapid acting antihypertensive medication within one hour compared with 54 of 104 (55%) of patients in the post-implementation cohort (35% vs 55%, RR 1.40 95% CI 1.07-1.82). Significantly more patients followed up for a blood pressure check within one week of discharge (41% vs 31%; p=0.02). There was not a significant effect on the administration of IV magnesium sulfate or initiation of oral medications postpartum. An automated EHR alert improved timely administration of rapid-acting antihypertensive medications for hypertensive emergency and has the potential to improve compliance with national preeclampsia guidelines.

Efficacy of nifedipine versus hydralazine in the management of severe hypertension in pregnancy: A randomised controlled trial.

Despite the availability of effective antihypertensive drugs, the quality of evidence regarding the best antihypertensive agent for the treatment of hypertensive emergencies in pregnancy is still poor. The aim of this study was to compare the efficacy and side effects of oral nifedipine and intravenous hydralazine for control of blood pressure (BP) in severe hypertension in pregnancy. An open-label, parallel, randomised, controlled trial of 78 pregnant women (≥28 weeks' gestation) with severe hypertension was conducted. Severe hypertension was defined as systolic BP of 160 mmHg or above and/or diastolic BP of 110 mmHg or above. They were randomly (1:1 ratio) administered oral nifedipine 20 mg or intravenous hydralazine 10 mg every 30 min up to 5 doses or until the target BP of 140-150 mmHg systolic and 90-100 mmHg diastolic was achieved. Intravenous labetalol was given if the primary treatment failed. The primary outcome measure was the number of doses needed to achieve targeted BP. The secondary outcome measures were the time needed to achieve desired BP, maternal adverse effects and perinatal outcome. The sociodemographic characteristics did not differ between the two study groups. The average number of dosages (nifedipine; 1.4 ± 0.6 vs. hydralazine; 1.7 ± 0.5, P = 0.008) needed to control the BP was lower in the nifedipine arm. Time (min) taken to control the BP was similar between the groups (hydralazine; 43.7 ± 19.7 vs. nifedipine; 51.2 ± 18.9, P = 0.113). Adverse maternal and perinatal effects did not differ in the study groups. Oral nifedipine and intravenous hydralazine showed comparable efficacy in the BP control in the severe hypertensive disorders of pregnancy without significant difference in adverse maternal and perinatal outcomes. However, further studies are required to explore the role of these drugs in BP control during hypertensive emergencies in pregnancy. (Identification number: NCT04435210).

English

English

Hydralazine Versus Nifedipine For Acute Hypertensive Emergency In Pregnancy: A Randomized Controlled Trial

(Am J Obstet Gynecol. 2017;217:687.e1–687.e6) Hypertensive disorders of pregnancy can contribute to maternal and fetal mortality and morbidity. Timely antihypertensive therapy is recommended to lower severe hypertension in preeclamptic women during pregnancy. Intravenous hydralazine, intravenous labetalol, and oral nifedipine are commonly used to control the blood pressure (BP) in such women, but there is a paucity of evidence regarding the best option for the acute control of BP in the setting of severe sustained hypertension. This double-blind, randomized, controlled trial was conducted to determine the efficacy of 2 commonly used agents—intravenous hydralazine and oral nifedipine—for controlling acute severe hypertension in pregnant women with preeclampsia.

Hydralazine vs nifedipine for acute hypertensive emergency in pregnancy: a randomized controlled trial

There is a paucity of good quality evidence regarding the best therapeutic option for acute control of blood pressure during acute hypertensive emergency of pregnancy. We sought to compare the efficacy of intravenously administered hydralazine and oral nifedipine for acute blood pressure control in acute hypertensive emergency of pregnancy. In this double-blind, randomized, controlled trial, pregnant women (≥24 weeks period of gestation) with sustained increase in systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg were randomized to receive intravenous hydralazine injection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection every 20 minutes until the target blood pressure of 150 mm Hg systolic and ≤100 mm Hg diastolic was achieved. Crossover treatment was administered if the initial treatment failed. The primary outcome of the study was time necessary to achieve target blood pressure. The secondary outcomes were the number of dosages required, adverse maternal and neonatal effects, and perinatal outcome. From December 2014 through September 2015, we enrolled 60 patients. The median time to achieve target blood pressure was 40 minutes in both groups (intravenous hydralazine and oral nifedipine) (interquartile interval 5 and 40 minutes, respectively, P = .809). The median dose requirement in both groups was 2 (intravenous hydralazine and oral nifedipine) (interquartile range 1 and 2 doses, respectively, P = .625). Intravenous hydralazine was associated with statistically significantly higher occurrence of vomiting (9/30 vs 2/30, respectively, P = .042). No serious adverse maternal or perinatal side effects were witnessed in either group. Both intravenous hydralazine and oral nifedipine are equally effective in lowering of blood pressure in acute hypertensive emergency of pregnancy.

Comparative Study of Efficacy and Safety of Intravenous Labetalol and Intravenous Hydralazine in managing Hypertensive Emergencies in Pregnancy

ABSTRACT Objectives Evaluation of efficacy and safety of intravenous labetalol and intravenous hydralazine in managing hypertensive emergency in pregnancy. Study design An open, randomized comparison of intravenous labetatol vs intravenous hydralazine was conducted in 100 pregnant women presenting with hypertensive emergency during pregnancy. Materials and methods: Inclusion criteria Women with severe hypertension in pregnancy at 34 weeks of gestation or more, i.e., systolic BP ≥160 mm Hg or diastolic BP ≥ 110 mm Hg with or without proteinuria either in labor or not in labor. Results The antihypertensive efficacy of both the drugs was found to be comparable. The primary outcome in terms of BP control was achieved in both the groups. There were four treatment failures in labetalol group and none in hydralazine group. No significant difference was observed in maternal and fetal outcomes. Palpitation and tachycardia occurred significantly more often in patients treated with hydralazine. Bradycardia was significantly more frequent in labetalol group. The neonatal outcomes were similar per group. Conclusion The randomized clinical trial showed that labetalol and hydralazine fulfil the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy. Hydralazine has its side effects like palpitation, headache, oliguria, dizziness, muscle cramps, and nasal congestion, which mimic symptoms of deteriorating pre-eclampsia. Labetalol has a better side effect profile, but specific concerns have been raised about the risk of neonatal bradycardia. How to cite this article Singh R, Singh S, Singh S, Agarwal M, Anand S, Yadav NK. Comparative Study of Efficacy and Safety of Intravenous Labetalol and Intravenous Hydralazine in managing Hypertensive Emergencies in Pregnancy. J South Asian Feder Obst Gynae 2016;8(3):185-188.

Oral Nifedipine or Intravenous Labetalol for Hypertensive Emergency in Pregnancy

OBJECTIVE:To compare the effectiveness of orally administered nifedipine and intravenously administered labetalol for acute blood pressure control in hypertensive emergency of pregnancy.METHODS:In this double-blind, randomized, controlled trial, pregnant women with sustained increase in systolic blo

Hypertensive emergencies in pregnancy.

Hypertensive disorders of pregnancy complicate 7% to 10% of pregnancies and are among the major causes of maternal and perinatal morbidity and mortality. Recently American College of Obstetricians and Gynecologists Taskforce on Hypertension during Pregnancy modified the diagnosis and management of hypertension in pregnancy, recommending prompt diagnosis, admission, close monitoring, and treatment. They strive to decrease maternal mortality and systemic complications. Labetalol, hydralazine, or nifedipine are considered first-line treatment, and either can be used to stabilize the patient with similar outcomes. Definite treatment is delivery of the fetus and should be considered based on the etiology of the hypertensive crisis and gestational age.

What Agent Is Best for Managing Acute Hypertensive Emergency in Pregnancy

Hypertensive disorders affect as many as 10% of pregnancies worldwide. Largely because of safety concerns, hydralazine use has declined whereas

Oral Nifedipine or Intravenous Labetalol for Hypertensive Emergency in Pregnancy

To compare the effectiveness of orally administered nifedipine and intravenously administered labetalol for acute blood pressure control in hypertensive emergency of pregnancy. In this double-blind, randomized, controlled trial, pregnant women with sustained increase in systolic blood pressure of 160 mm Hg or higher or diastolic blood pressure of 110 mm Hg or higher were randomized to receive nifedipine (10 mg tablet orally up to five doses) and intravenous placebo saline injection or intravenous labetalol injection in escalating doses of 20, 40, 80, 80, and 80 mg and a placebo tablet every 20 minutes until the target blood pressure of 150 mm Hg systolic and 100 mm Hg diastolic, or lower, was achieved. Crossover treatment was administered if the initial treatment failed. The primary endpoint of the study was time necessary to achieve target blood pressure. Secondary endpoints were number of dosages required, adverse maternal and neonatal effects, side effect profile, and perinatal outcome. From October 2012 to April 2013, we enrolled 60 patients. The median time taken to achieve target blood pressure was 40 minutes (interquartile range, 20-60 minutes) compared with 60 minutes (interquartile range 40-85 minutes) for nifedipine and labetalol, respectively (P=.008). The median dose required was two (interquartile range 1-3) compared with three (interquartile range 2-4.25) for nifedipine and labetalol, respectively (P=.008). No serious adverse maternal or perinatal side effects were witnessed in either group. As administered in this trial, oral nifedipine lowered blood pressure more quickly than did intravenous labetalol during hypertensive emergency in pregnancy. Clinical Trials Registry-India, www.ctri.nic.in, CTRI/2013/02/003350. I.

Oral Nifedipine Versus Intravenous Labetalol for Acute Blood Pressure Control in Hypertensive Emergencies of Pregnancy

Oral Nifedipine Versus Intravenous Labetalol for Acute Blood Pressure Control in Hypertensive Emergencies of Pregnancy

A pelvic paraganglioma presenting as a hypertensive emergency in pregnancy

Paraganglia are neuroendocrine organs that originate from the neural crest cells that are closely associated with the autonomic nervous system. 1 Paragangliomas and phaeochromocytomas are tumours that arise from these organs. Paragangliomas are extra-adrenal tumours that can be divided into sympathetic and parasympathetic, and are further categorised by site. 1 The term “phaeochromocytoma” is reserved for intra-adrenal tumours. The most common location of these extra-adrenal paragangliomas is the inferior para-aortic region (also known as the organ of Zuckerkandl). 1 Other extra-adrenal sites that have been described include the bladder, pelvis, prostate, ovaries and thorax. 1 According to McNicol, the estimated incidence of paragangliomas is 1:300 000. At least 30% of paragangliomas have a hereditary occurrence. Approximately 10% are syndromic. 1 We describe a case of extra-adrenal pelvic paraganglioma that caused hypertension in pregnancy.

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

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

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

To compare oral nifedipine with intravenous labetalol in their rapidity to control hypertensive emergencies of pregnancy. A double-blind randomised trial. A university hospital in Malaysia. Pregnant women with severe gestational hypertension≥160/110 mmHg who required immediate treatment. Patients were randomised to receive nifedipine (10 mg tablet, orally, up to five doses) and intravenous placebo saline injection or intravenous labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) and a placebo tablet every 15 minutes until the target blood pressure of ≤150/100 mmHg was achieved. Crossover treatment was effected if the initial treatment regimen was unsuccessful. MAIN OUTCOME MEASURE The time taken to achieve a blood pressure of ≤150/100 mmHg. The median time taken to achieve target blood pressure was 30 minutes (interquartile range, IQR 22.5-67.5 minutes) versus 45 minutes (IQR 30-60 minutes) for nifedipine and labetalol, respectively (P=0.59). Repeated measures analysis of variance indicated that in the first hour both systolic (F=87.6, P<0.001) and diastolic (F=55.8, P<0.001) blood pressure significantly decreased, but there was no difference between the nifedipine and labetalol groups for both systolic (F=0.12, P=0.74) and diastolic (F=0.92, P=0.34) blood pressure trends over time. Crossover treatment was required in 20% of women from each group. Oral nifedipine and intravenous labetalol regimens are similarly effective in the acute control of severe hypertension in pregnancy.

A Randomized Comparison of Hydralazine and Mini-bolus Diazoxide for Hypertensive Emergencies in Pregnancy: The PIVOT Trial

A Randomized Comparison of Hydralazine and Mini-bolus Diazoxide for Hypertensive Emergencies in Pregnancy: The PIVOT Trial

A randomised comparison of hydralazine and mini‐bolus diazoxide for hypertensive emergencies in pregnancy: The PIVOT trial

Diazoxide is one of few available agents for treatment of hypertensive emergencies in pregnancy. From previous studies, there is a question concerning safety after moderate-dose administration caused episodes of hypotension. Rapid control of severe hypertension is necessary to reduce maternal morbidity, for example, stroke and placental abruption. This study was designed to compare the efficacy of mini-bolus diazoxide with intravenous (i.v.) hydralazine. A randomised controlled trial. Tertiary referral maternity hospital, Royal Prince Alfred Women and Babies, Sydney Australia. Antenatal and postnatal women with severe hypertension. One hundred and twenty-four hypertensive women were randomised to either i.v. hydralazine (5 mg doses) or mini-bolus diazoxide (15 mg doses). Achievement of target blood pressure reduction; secondary measures included requirement for Caesarean section because of fetal deterioration as determined by non-reassuring cardiotocograph (CTG). Reduction in systolic and diastolic blood pressure was 34 min for hydralazine and 19 min for diazoxide (P < 0.001). There were no episodes of hypotension after diazoxide and one after hydralazine (after epidural). Episodes of persistent severe hypertension were more common with hydralazine (38%) than with diazoxide (16%), P < 0.01. The Caesarean section rate for no-reassuring CTG was no different between the two groups. Neonatal outcomes were similar. Diazoxide and hydralazine are safe and effective antihypertensives, showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy. The mini-bolus doses of 15 mg of diazoxide did not precipitate maternal hypotension as previously described and reduces episodes of persistent severe hypertension.

Acute hypertensive emergencies in pregnancy

Obstetrical hypertensive emergencies are life-threatening conditions involving significant risk to both the mother and fetus. Aggressive treatment of the maternal hypertensive state requires an initial consideration of the effect of treatment on the fetus, via changes to the uteroplacental circulation with treatment. The challenge then is to correct blood pressure using appropriate, safe pharmacologic agents to prevent catastrophic maternal consequences, while minimizing acute changes to placental perfusion and any corresponding fetal ill effects. Hypertension in pregnancy may be one manifestation of a multiple-system pathologic process, as is the case in preeclampsia. Blood pressure control, along with delivery, will be the first step in treating the renal, hematologic, hepatic, and cardiac dysfunction that can be seen in preeclampsia. A review of medications most commonly used for hypertensive emergencies in pregnancy. Hypertensive emergencies in pregnancy require prompt evaluation and treatment in an intensive care setting to prevent untoward effects to both the fetus and mother.