Methyldopa Treatment Research Articles

A Pilot Study of the Maternal-Fetal Pharmacokinetics of Furosemide in Plasma, Urine, and Amniotic Fluid of Hypertensive Parturient Women Under Cesarean Section.

The third trimester of pregnancy is related to physiological changes that can modify the process of absorption, distribution, metabolism, and excretion and, consequently, the efficacy and toxicity of drugs. However, little is known about furosemide pharmacokinetics and placental transfer in pregnancy. This study evaluated the maternal-fetal pharmacokinetics and distribution to amniotic fluid of furosemide in hypertensive parturient women under cesarean section. Twelve hypertensive parturient women under methyldopa (250 mg/8 h) and/or pindolol (10 mg/12 h) treatment received a 40-mg single oral dose of furosemide 1 to 10 hours before delivery by cesarean section. Blood and urine samples were collected for 12 hours after furosemide administration. At delivery, samples were obtained from maternal and umbilical cord blood (n = 8) to assess the transplacental transfer. Amniotic fluid (n = 4) was collected at the time of delivery. The following furosemide pharmacokinetic parameters were obtained as median (interquartile range): Cmax , 403 ng/mL (229 to 715 ng/mL); Tmax , 2.00 hours (1.50 to 4.83 hours); elimination half-life (t1/2 ), 2.50 hours (1.77 to 2.97 hours); AUC0-12 h , 1366 ng⋅h/mL (927 to 2531 ng⋅h/mL); AUC0-∞ , 1580 ng⋅h/mL (1270 to 2881 ng⋅h/mL); CL/F 25.3 L/h (13.8 to 31.4 L/h); CLR, 2.50 L/h (1.77 to 2.97 L/h); CLNR, 22.7 L/h (12.1 to 25.6 L/h); and Vd /F 82.8 L (34.4 to 173 L). The transplacental transfer of furosemide was 0.43 (0.10 to 0.73), and the amniotic fluid concentration was 11.0 ng/mL (5.51 to 14.6 ng/mL). From a clinical point of view, these results suggest that substrates of uridine diphosphate-glucuronosyltransferase isoenzymes such as furosemide may have increased clearance during pregnancy and could require dose adjustment in this population.

Quintuplet Pregnancy: A Rare Case after Clomiphene Citrate Therapy and Review of Literature

Multiple pregnancies are increasing with the progress in Assisted Reproductive Technology. The authors report a case of quintuplet pregnancy after Clomiphene Citrate stimulation. This is a 28-year-old woman, G2, P1 with a 4-year-old child alive, who consulted for maternity desire. She was treated with Clomiphene Citrate at 100 mg daily for five days. The presence of a quintuplet pregnancy at 8 weeks + 5 days was found by ultrasound on 29/12/2018. During the follow up of the pregnancy, she presented pre-eclampsia from 24th week (TA 140/100 mmHg, significant proteinuria, edema of lower limbs). Methyl Dopa treatment was instituted. Tocolytic treatment with Salbumol was prescribed facing uterine contractions at 30 weeks. The patient had premature rupture of membranes at 34 weeks + 4 days, followed by uterine contractions. She had a cesarean section at the same day with the birth of five newborns alive. This is the first reported case in Burkina Faso.

Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes

Aim: To evaluate whether initiation of anti-hypertensive treatment with methyldopa affects fetal hemodynamics in women with pregestational diabetes. Methods: Prospective study of unselected singleton pregnant women with diabetes (seven type 1 and two type 2 diabetes), normal blood pressure and kidney function at pregnancy booking. Methyldopa treatment was initiated at blood pressure >135/85 mmHg and/or urinary albumin excretion (UAE) >300 mg/g creatinine. Pulsatility indices (PI) of the uterine, umbilical, middle cerebral arteries before and 1 week after initiation of methyldopa treatment (250 mg three times daily) was performed and the cerebro-placental ratio (CPR) was calculated. Results: Methyldopa treatment was initiated at median 249 (range 192–260) gestational days, mainly due to gestational hypertension (n = 7). Blood pressure declined from 142 (112–156)/92 (76–103) mmHg before to 129 (108–144)/82 (75–90) mmHg after initiation of methyldopa treatment (p = 0.11 and 0.04 for systolic and diastolic blood pressure, respectively). There were no significant changes in the umbilical artery PI (0.82 (0.72–1.40) versus 0.87 (0.64–0.95), p = 0.62) or CPR (1.94 (0.96–2.33) versus 1.78 (1.44–2.76), (p = 0.73). Gestational age was 265 (240–270) d. Apgar scores were normal. Conclusions: Stable Doppler flow velocity waveforms were documented after initiation of methyldopa treatment for pregnancy-induced hypertensive disorders in this cohort of pregnant women with pregestational diabetes.

Importance of Direct Antiglobulin Test (DAT) in Cord Blood: Causes of DAT (+) in a Cohort Study

The direct antiglobulin test (DAT) is the cornerstone of the diagnosis of hemolytic disease of the newborn (HDN). The aim of this study was to review the incidence and causes of positive DAT in cord blood in relation to development of HDN. We retrospectively reviewed all results of DAT, which is routinely performed in cord blood samples, along with the laboratory and infants' medical records. DAT was positive in 70/2695 (2.59%) cases. In 64/70 (91.43%) cases, DAT positivity was attributed to ABO incompatibility. There were 50/218 (22.93%) DAT (+) cases in the A/O group and 13/97 (13.40%) cases in the B/O group (p = 0.0664). Two DAT (+) cases were attributed to maternal alloimmunization (anti-Fya and anti-JKb, respectively), and one to maternal IgG autoantibodies that developed after methyldopa treatment. Among the 70 DAT (+) cases, 30 (42.86%) cases required phototherapy with no difference between the A/O and B/O groups. The duration of phototherapy in the B/O group was significantly longer than in the A/O group (p = 0.024). There was a trend of correlation of increasing strength of DAT positivity with phototherapy need. No false positive DAT case was detected. Although ABO incompatibility remains the main reason of DAT (+), other causes (e.g., alloimmunization, drugs) should also be explored. The relevant impact of DAT (+) on HDN development should be considered.

Investigation of the effects of the chronic administration of some antihypertensive drugs on enzymatic and non-enzymatic oxidant/antioxidant parameters in rat ovarian tissue

Objective. In this study, effects of chronic antihypertensive drug (clonidine, methyldopa, amlodipine, ramipril, and rilmenidine) treatment on antioxidant–oxidant parameters were investigated in rat ovarian tissue.Study design. Chronic drug administration for 30 days and at the end, biochemical examinations (total glutathione (tGSH), glutathione peroxidase (GPO), glutathione reductase (GR), glutathione s-transferase (GST), superoxide dismutase (SOD), nitric oxide (NO), catalase (CAT), malondialdehyde (MDA), and myeloperoxidase (MPO) analyses) were performed.Results. The levels of glutathione (GSH) and NO, and the activities of GPO, GR, GST, SOD, and CAT were measured the lowest in ramiprile group. Also in ramiprile group, the level of MDA and the activity of MPO was the highest.Conclusion. We divided the drugs into four groups according to their biochemical side effect potentials in ovarian tissue: (I) Drugs which have no clear negative effect on ovarian tissue: clonidine, rilmenidine; (II) Drugs which have mild negative effect on ovarian tissue: methyldopa; (III) Drugs which have moderate negative effect on ovarian tissue: amlodipine; (IV) Drugs which have severe negative effect on ovarian tissue: ramipril. These data might be useful in the selection of the least toxic antihypertensive drug in pregnant and/or normal females.

GESTATIONAL HYPERTENSION: RISK FACTORS, CLINICAL AND LABORATORY FINDINGS: PP.32.294

Gestational hypertension is not an uncommon situation. Previous studies have shown up hypertensive disorders complicate 5 to 10 percent of pregnancies. Multiple risk factors in gestational hypertension development have been described, just as: previous obstetrical preeclampsia history, first pregnancy, age, hypertension family history, obesity, multiple gestation… We have collected all gestational hypertension cases and its clinical and laboratory findings from our hospital between 1st January 2003 and 31st December 2009. We have evaluated 46 women. As a result of, we have found out the hypertension beginning was of 24.02 +/− 12.36 weeks. The gestation ending was of 36.65 +/− 2.70 weeks [5% women by caesarean section]. 15 women [32.6%] had developed hypertension in previous pregnancy and 17 [37%] had hypertension familiar history. Only 6 women [15.9%] were diabetic or had developed gestational diabetes. The most frequent antihypertensive treatment was Captopril [85.4%] followed by nifedipine [34,8%], labetalol [30.4%], and methyldopa [15.2%]. The most frequent laboratory findings were low levels of albumin [3.18 +/− 0.53], proteinuria [1.20 +/− 1.82] and a rise level in LDH [520.65 +/− 408], uric [6.02 +/− 1.7], and AST [44.13 +/− 87.36], ALT [44.35 +/− 72.06]. Hypertension familiar history patients have a bigger proteinuria [p = 0.06]. It was more frequent the hypertension development of a previous gestation [p = 0.024] and hypertension beginning after gestation [p = 0.014]. The gestational hypertension beginning was earlier in women with a previous pregnancy hypertension history [p = 0.001]. Finally, patients who required methyldopa treatment ended their pregnancy before the others [p = 0.039].

The effect of methyldopa treatment on uterine, umblical and fetal middle cerebral artery blood flows in preeclamptic patients.

The purpose of this study was to evaluate the efficacy of methyldopa in the treatment of preeclamptic patients. This study was performed on 24 preeclamptic women who were in between 25-36 weeks of gestational age. 24 healthy pregnant women were taken as control group. Before starting treatment, 24 preeclamptic patients were examined with Doppler ultrasound. Pulsatility index, resistance index, systolic/diastolic ratio of uterine, umblical and fetal middle cerebral arteries were measured. Preeclamptic patients were treated with totally 1 g methyldopa per day. After 7 d, patients were reexamined with Doppler ultrasound. The effect of methyldopa on uterine, umblical and fetal middle cerebral artery blood flows were detected. Only one control with Doppler ultrasound was done to the healthy pregnant women. Before methyldopa treatment to the preeclamptic women, pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) on uterine and umblical arteries were significantly higher than the control group. However, fetal middle cerebral artery (MCA) values were significantly lower than the control group. When Doppler results of preeclamptic patients before and after the methyldopa treatment were compared, no significant differences in terms of Pulsatility Index, Resistance IndexI and S/D ratio of umblical and fetal middle cerebral arteries were found. However, the results of uterine artery were significantly lower after the treatment in preeclamptic patients. Treatment with methyldopa lowered the uterine artery resistance in preeclamptic patients but did not effect the resistance of umblical and fetal middle cerebral artery.

Comparison of Magnesium and Methyldopa for the Control of Blood Pressure in Pregnancies Complicated with Hypertension

Objectives: Although magnesium is now the drug of choice for the prevention of eclamptic seizures only few studies have evaluated whether magnesium may reduce blood pressure in pregnancies complicated with hypertension. Methods: A total of 33 patients with pregnancy-induced hypertension were randomized to either magnesium or methyldopa treatment. Of these 16 received magnesium and 17 methyldopa. The treatment comprised a 48-hour magnesium infusion followed by oral magnesium tablets until 3 days after delivery or 250 mg methyldopa 4 times a day in a similar period. Results: Patients treated with magnesium had 1 day after inclusion a statistically significantly lower systolic blood pressure compared to the level in the methyldopa group (138.1 ± 11 vs. 147.6 ± 11 mm Hg; p < 0.05), but no difference was observed in diastolic blood pressure (92.0 ± 6.6 vs. 96.0 ± 10.1 mm Hg; NS). From the 5th day of inclusion and until delivery both systolic and diastolic blood pressure were significantly lower in the magnesium group (p < 0.05). Including all blood pressure measurements in a single analysis showed that both systolic (138 ± 13 vs. 148 ± 15 mm Hg; p < 0.0001) and diastolic (92 ± 10 vs. 94 ± 10 mm Hg; p < 0.05) blood pressure were lower in the magnesium group compared to the methyldopa group. There was no difference between the two groups regarding gestational age at delivery, birth weight, Apgar scores and pH in umbilical cord blood. Conclusion: This preliminary study demonstrates that magnesium treatment lowers blood pressure in pregnancies complicated with hypertension. The effect is without any adverse effect on maternal and neonatal well-being.

Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension

Our purpose was to study the effect of methyldopa on uteroplacental and fetal hemodynamics in women with pregnancy-induced hypertension. A prospective study of Doppler ultrasonographic blood flow data before and after 1 week of methyldopa treatment was conducted at the Department of Obstetrics and Gynecology, National University Hospital, Singapore, in 20 women (mean 35 weeks' gestation) with pregnancy-induced hypertension. The main outcome measures were maternal blood pressure, maternal and fetal heart rate, and blood velocity waveforms characterized by the pulsatility index in the fetal ascending aorta, middle cerebral artery, umbilical artery, and maternal uterine and arcuate arteries. Statistical evaluation was performed with t tests for paired observations. Maternal mean arterial blood pressure was reduced 9.7 mm Hg (95% confidence interval -13.8 to -5.6), and mean heart rate decreased 6.3 beats/min (95% confidence interval -11.1 to -1.4). Mean pulsatility index in the uterine (0.93 to 0.92) and arcuate arteries (0.61 to 0.73) were unchanged after treatment. Fetal hemodynamic changes before and after treatment were not significant. Fetal and neonatal outcome was uneventful. Short-term treatment with methyldopa in the last trimester in women with pregnancy-induced hypertension reduced maternal blood pressure and heart rate but had no adverse effects on uteroplacental and fetal hemodynamics.

Risk of serious morbidity associated with hydralazine versus methyldopa treatment in hypertensive patients

The medical records of patients presenting to the Hammersmith Hospital hypertension clinic between 1971 and 1981 were examined to determine presenting clinical data, treatment regimes, and both cardiovascular and non cardiovascular mortality and morbidity. When compared with 1004 patients receiving treatment other than hydralazine 310 patients on hydralazine had a significantly higher risk of developing renal disease (RR = 2.71) in men, and severe weight loss in women (RR = 3.06). Renal disease risk also tended to be high in women on hydralazine (RR = 1.95) compared with all other treatments, but this was not statistically significant and could be explained by poorer renal function and significantly higher untreated blood pressure in the hydralazine treated group at presentation. The 422 patients who were treated with methyldopa but not hydralazine had similar risk factors for cardiovascular disease compared with a group of 167 who received hydralazine but not methyldopa. Comparisons of event rates failed to find significant differences in morbidity or mortality between these two groups. The age adjusted male mortality was 14/1000 patient years on hydralazine and 12/1000 on methyldopa and 13/1000 and 6/1000 years for women respectively. There was no evidence of an increased risk of either renal disease (RR = 0.3 in men, RR = 0.3 in women) on hydralazine or weight loss (RR = 0.7 in men, RR = 1.6 in women), with similar presenting data. Systemic lupus erythematosus was a rare complication (2 of 314) of treatment with hydralazine.

Effect on Atrial Natriuretic Peptides of Chronic Treatment With α-Methyldopa and Hydralazine in Spontaneously Hypertensive Rats

The present study was designed to examine the effect of antihypertensive therapy on plasma and atrial concentration of atrial natriuretic peptides (ANP) in spontaneously hypertensive rats (SHR) by using alpha-methyldopa and hydralazine. Methyldopa and hydralazine treatment reduced blood pressure (P less than .05, P less than .05, respectively); however, ventricular weight was reduced by methyldopa (P less than .05) but not by hydralazine. Plasma ANP concentration in untreated SHR was higher than that observed in Wistar-Kyoto rats (WKY). Methyldopa treatment decreased plasma ANP concentration, but hydralazine treatment did not. Moreover, plasma ANP concentration and ventricular weight were positively correlated in untreated and treated SHR. The left atrial ANP concentration in untreated SHR was lower than that observed in WKY. Methyldopa treatment increased left atrial ANP concentration, but hydralazine treatment did not. These results suggest that the ANP release from the left atrium is chronically stimulated in adult SHR, and that a decrease in plasma ANP concentration by methyldopa treatment is, in part, associated with the decline of ANP release from the heart due to the reductions of blood pressure and cardiac hypertrophy.

Neonatal Nasal Obstruction Associated With Methyldopa Treatment During Pregnancy

Sir.—Methyldopa is used frequently in the long-term management of hypertension in pregnancy because of its documented effectiveness and relative lack of fetal toxicity.1,2Although not reported in neonates, nasal congestion is a known side effect of methyldopa in 1% to 3% of adults and children receiving long-term therapy.3We report an association between maternal administration of methyldopa and neonatal nasal obstruction. Patient Reports.—Patient1.—A 38-year-old gravida 3, para 1, aborta 1 woman underwent an elective cesarean section at 39 weeks' gestation because of frank breech fetal position, maternal hypertension, and advanced maternal age. She was treated with methyldopa (250 mg orally twice a day) since the eighth week of gestation. At delivery, a loop of cord was noted around the neonate's neck and there was moderate difficulty in delivering the head. The Apgar scores were 3,8, and 9 at 1,5, and 10 minutes, respectively, and

Altered cardiac polyamine biosynthesis in spontaneously hypertensive rats.

To evaluate the role of polyamine biosynthesis in myocardial growth, the activity of ornithine decarboxylase (ODC) and the levels of the polyamines, spermidine, spermine, and putrescine, were measured in the hearts of spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) rats between birth and 30 wk of age and in 30-wk-old rats after 6 wk treatment with either minoxidil (0.08 mg/ml) or methyldopa (5 mg/ml drinking water). ODC activity was initially high in the developing heart (150 pmol X mg protein-1 X 30 min-1) and decreased with age. In the SHR after 4 wk of age, spermidine content was consistently raised in both ventricles compared with the WKY rats. Spermine was reduced in the left ventricle of the SHR, resulting in high spermidine-to-spermine ratios characteristic of rapidly growing systems. Ventricular ODC activity and putrescine levels were also slightly but less consistently elevated in the ventricles of the SHR compared with respective WKY rats. Minoxidil treatment increased heart weight and left ventricular spermidine and spermine content in both SHR and WKY rats. Methyldopa also caused a significant increase in left ventricular spermidine content despite a marked reduction in ventricular mass. Thus ventricular hypertrophy in SHR is accompanied by an enhanced synthesis and accumulation of spermidine. The fact that myocardial spermidine content increased during methyldopa treatment, which reduced the myocardial mass, suggests that regression of ventricular hypertrophy can occur independently of changes in polyamine content.

Reproductive toxicology of methyldopa in male F344/N rats

Methyldopa, a widely used antihypertensive drug, was administered to male Fischer 344/N rats by gavage 5 days/week for 65 days at dosages of 0, 50, 100, 200, or 400 mg/kg. Decreased body weight was seen in treated animals. After mating to untreated female Fischer 344/N rats on days 57–61, the male rats were necropsied (days 65–67) and reproductive toxicity was measured by sperm count, sperm motility, organ weights, hormone levels and histologic evaluation of the testis. Decreased fertility was seen in males dosed with 200 or 400 mg/kg methyldopa. Decreases were also seen in sperm count, sperm motility, apparent number of late spermatids, and plasma testosterone levels in males in the 200 and 400 mg/kg groups. This alteration of reproductive function in male rats was found to be reversible after a 13-week recovery period without dosing. The marked decrease in circulating testosterone levels following methyldopa treatment at 200 or 400 mg/kg may have contributed to the reproductive toxicity of this drug.

Methyldopa: Effects on the murine immune system

Mice were treated for 7 weeks with doses of methyldopa somewhat exceeding those given to man, and mixed immunotoxic effects were observed. Daily subcutaneous injections of 5 mg (in 0.1 ml) methyldopa or saline (0.1 ml) did not generally alter body weights, except on day 19, when the methyldopa-treated mice weighed significantly less. During treatment, all mice were immunized twice with sheep red blood cells (SRBC) and bled four times. Anti-SRBC titers were not affected by methyldopa treatment, but leukocyte counts were dramatically decreased, and hematocrits to a lesser degree. Although in methyldopa-treated mice spleen and kidneys were increased in size, liver, lung, heart, and thymus size was not affected. These results are discussed in the context of other studies on the mode of action of methyldopa in eliciting an autoimmune anemia in man treated therapeutically with this drug.

Methyldopa does not alter the disposition of digoxin.

To investigate whether methyldopa alters digoxin disposition, eight healthy subjects received methyldopa titrated to 250 mg t.i.d. or placebo in a double-blind, cross-over manner for 16 consecutive days, with 0.25 mg intravenous digoxin coadministered on day 5 and 0.25 mg oral digoxin on days 9 to 16. Digoxin concentrations in plasma and urine were measured by RIA. Although assay sensitivity did not allow an adequate assessment of serum AUC(0-infinity) after intravenous administration, mean digoxin AUC(0-24) was 10.2 +/- 3.5 and 10.0 +/- 1.8 ng/ml X hr with placebo and methyldopa, respectively (P greater than 0.05). Mean urinary excretion after digoxin with or without methyldopa treatment was 0.204 +/- 0.34 and 0.197 +/- 0.38 mg, respectively. The mean steady-state serum concentrations of oral digoxin (AUC(0-24)/zeta) with and without methyldopa were 0.65 +/- 0.2 and 0.62 +/- 0.3 ng/ml, respectively. These data revealed no significant differences (P greater than 0.05) for various parameters with power of greater than 0.8 to detect meaningful differences of approximately 30 per cent. Thus, methyldopa did not alter digoxin disposition in healthy subjects, and a pharmacokinetic interaction in patients is unlikely.

Final Report of Study on Hypertension during Pregnancy

195 (97.5%) children born to hypertensive women participating in a trial of methyldopa treatment during pregnancy were followed from birth and were extensively examined at the age of 7 1/2 years. The frequency of problems with health, physical or mental handicap, sight, hearing, and behaviour was the same in children of treated and untreated women. Sons of the untreated women were heavier and taller than those of treated women, as were their mothers. Among children of women who entered the trial between 16 and 20 weeks' gestation, sons of untreated women had larger heads than sons of treated women, but there was no difference in mean intelligence quotients. There were no significant differences between the children in the treated and untreated groups in standing and supine blood pressures, or fourteen tests of ability. Methyldopa therefore seems safe to use in pregnancy and is probably preferable to other drugs from the point of view of the neonate and child.

Effects of pindolol and methyldopa on blood pressure and plasma norepinephrine

Thirty patients with essential hypertension (supine diastolic blood pressure 100 to 115 mm Hg) were treated in a randomized, double-blind study with either pindolol (mean dose 28 ± 5 mg twice a day) or methyldopa (673 ± 158 mg three times a day) for 12 weeks after a 3-week, single-blind placebo period. In 17 pindolol-treated patients mean supine blood pressure was 163 ± 3 106 ± 1 during the placebo period and 155 ± 3 99 ± 2 mm Hg ( p < 0.01) during the high-dose period. In 13 patients treated with methyldopa mean supine blood pressure fell from 160 ± 4 104 ± 1 to 156 ± 5 97 ± 2 mm Hg . Mean standing heart rate was reduced during pindolol therapy from 84 ± 2 to 79 ± 2 bpm ( p < 0.05) but was unchanged during methyldopa treatment. Mean supine pretreatment plasma norepinephrine fell from 379 ± 40 to 337 ± 33 pg/ml in patients on pindolol therapy and from 448 ± 76 to 223 ± 39 pg/ml ( p < 0.02) in the methyldopa-treated group. Although norepinephrine generally decreased in pindolol responders and not in nonresponders, changes in supine diastolic blood pressure and supine plasma norepinephrine did not correlate. In contrast, norepinephrine declined consistently in methyldopa-treated patients regardless of the blood pressure response; changes in diastolic blood pressure and norepinephrine correlated ( r = 0.59; p < 0.05). The results suggest that suppression of sympathetic nervous system activity may play a role in the hypotensive effect of both pindolol and methyldopa.

FINAL REPORT OF STUDY ON HYPERTENSION DURING PREGNANCY: THE EFFECTS OF SPECIFIC TREATMENT ON THE GROWTH AND DEVELOPMENT OF THE CHILDREN

195 (97·5%) children born to hypertensive women participating in a trial of methyldopa treatment during pregnancy were followed from birth and were extensively examined at the age of 71/2 years. The frequency of problems with health, physical or mental handicap, sight, hearing, and behaviour was the same in children of treated and untreated women. Sons of the untreated women were heavier and taller than those of treated women, as were their mothers. Among children of women who entered the trial between 16 and 20 weeks' gestation, sons of untreated women had larger heads than sons of treated women, but there was no difference in mean intelligence quotients. There were no significant differences between the children in the treated and untreated groups in standing and supine blood pressures, or fourteen tests of ability. Methyldopa therefore seems safe to use in pregnancy and is probably preferable to other drugs from the point of view of the neonate and child.

Improvement in left ventricular function after chronic treatment with methyldopa in hypertensive patients with left ventricular hypertrophy

SummaryA study was carried out in 18 hypertensive patients, 10 with left ventricular hypertrophy, to investigate the effect of long-term treatment with methyldopa (750 mg to 3 g daily for 6 months) on left ventricular function. Patients with coronary artery disease were excluded. Sustained isometric hand grip and cold pressor tests were used to increase afterload, and changes in left ventricular function were monitored with radionuclide angiography. The results showed that, in addition to producing significant reductions in systolic and diastolic blood pressure, the reduction in the left ventricular ejection fraction which occurred during the provocative tests in patients with left ventricular hypertrophy was either controlled or attenuated after methyldopa treatment.