Treatment Of Hypertension In Pregnancy Research Articles

A comprehensive review of the diagnosis and treatment of hypertension in pregnancy based on the latest guidelines of the American Association of Obstetrics and Gynecology

A comprehensive review of the diagnosis and treatment of hypertension in pregnancy based on the latest guidelines of the American Association of Obstetrics and Gynecology

Comparison between adverse effects of I/v Inj Labetalol Vs Inj Hydralazine during treatment of Hypertension in pregnancy

Aim: To examine and compare side effects of intravenous Labetalol and Hydralazine in the treatment of Hypertension in pregnancy in developing countries like Pakistan. Methodology: A six-month randomised controlled experiment was undertaken at the Lady Aitchison Hospital's, Department of Obstetrics and Gynaecology. In the study, 330 individuals with severe hypertension who were between the ages of 20 and 35 years old and had been pregnant for more than 20 weeks were included. Patients were split into two groups of equal size. Group A was administered a 20mg IV bolus of Labetalol while Group B was administered a 5-10mg IV bolus of Hydralazine. The patients were monitored during the administration period of 60 minutes and all this data was entered into a proforma. Results: Females had an average age of 27.43±3.47 years and average gestational age in females was 28.98±4.49 weeks. The systolic blood pressure in all females was 109.43 ±16.93mmHg after 60 minutes of therapy, and mean diastolic blood pressure was 77.28±14.73mmHg. A total of 135(40.9%) women suffered from maternal hypotension [27(16.36%) with Labetalol vs 108(65.43%) with Hydralazine], and 55(16.68%) females exhibited abnormal fetal heart rate [1 (0.61%) with Labetalol and 54(32.72%) with Hydralazine]. Therefore, the Hydralazine adverse effect was statistically significant (p-value = 0.000). Practical Implication: If the results of this study are applied in clinical practice in patients of pregnancy induced hypertension, female patients ca be prevented of side effects of hydralazine by using labetalol to treat hypertension in pregnancy, so it is very beneficial for patients. Conclusion: The study concludes that use of Hydralazine in females with PIH should be discouraged, whereas the use of Labetalol should be encouraged in a developing country like Pakistan. Keywords: Pregnancy Induced Hypertension (PIH),Gestational Hypertension(GH), hypotension, headache, abnormal fetal heart rate, palpitation, tachycardia, intravenous.

Antihypertensives in Pregnancy

Hypertensive disorders of pregnancy (HDP) can result in significant maternal morbidity and even mortality. Available data suggest that many antihypertensives can be safely used in pregnant patients, albeit with close supervision of parameters like fetal growth and amniotic fluid volume. This article summarizes current guidelines on the diagnosis and treatment of hypertension in pregnancy and provides an in-depth guide to the available safety and efficacy data for antihypertensives during pregnancy and postpartum.

Timely Recognition and Treatment of Hypertension in Pregnancy: Key to Preventing Severe Maternal Morbidity and Mortality.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Each author has indicated that he or she has met the journal's requirements for authorship.

Treatment of mild chronic hypertension in pregnancy reduces pre-eclampsia risk.

Treatment of mild chronic hypertension in pregnancy reduces pre-eclampsia risk.

Home blood pressure monitoring in the diagnosis and treatment of hypertension in pregnancy: a systematic review and meta-analysis.

Background:Home blood pressure monitoring is increasingly used for pregnant individuals; however, there are no guidelines on such monitoring in this population. We assessed current practices in the prescription and use of home blood pressure monitoring in pregnancy.Methods:We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We conducted a structured search through the MEDLINE (from 1946), Embase (from 1974) and CENTRAL (from 2018) databases up to Oct. 19, 2020. We included trials comparing office and home blood pressure monitoring in pregnant people. Outcomes included patient education, home blood pressure device, monitoring schedule, adherence, diagnostic thresholds for home blood pressure, and comparison between home and office measurements of blood pressure.Results:We included in our review 21 articles on 19 individual studies (1 RCT, 18 observational) that assessed home and office blood pressure in pregnant individuals (n = 2843). We observed variation in practice patterns in terms of how home monitoring was prescribed. Eight (42%) of the studies used validated home blood pressure devices. Across all studies, measurements were taken 3 to 36 times per week. Third-trimester home blood pressure corresponding to office blood pressure of 140/90 mm Hg after application of a conversion factor ranged from 118 to 143 mm Hg (systolic) and from 76 to 92 mm Hg (diastolic), depending on the patient population and methodology. Systolic and diastolic blood pressure values measured at home were lower than office values by 4 (95% confidence interval [CI] −6 to −3) mm Hg and 3 (95% CI −4 to −2) mm Hg, respectively.Interpretation:Many issues related to home blood pressure monitoring in pregnancy are currently unresolved, including technique, monitoring schedule and target values. Future studies should prioritize the use of validated home measuring devices and standardized measurement schedules and should establish treatment targets. PROSPERO registration:CRD42020147352

Kynurenine Relaxes Arteries of Normotensive Women and Those With Preeclampsia.

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Clinical Efficacy Analysis of Nifedipine Combined with Low Molecular Weight Heparin in the Treatment of Pregnancy Hypertension

This research aims to investigate nifedipine and low molecular weight heparin clinical efficacy in cure patients with hypertension during pregnancy. A retrospective analysis of 180 patients with hypertension during pregnancy admitted to the obstetric ward of our hospital from December 2017 to December 2020 was selected. Among them, 90 patients with hypertension during pregnancy were treated with nifedipine combined with low molecular weight heparin (observation group). Nifedipine was used to treat 90 patients with pregnancy-induced hypertension (control group). Contrast the blood pressure, D-dimer, pregnancy-related complications and adverse events incidence in both groups before and after treatment were compared. The observation group clinical effective rate was 90 % while the control group was 70 % (p<0.05). The blood pressure and D-dimer of both groups decreased obviously after treatment, but the observation group decreased more significantly than it (p<0.01). The observation group incidence of pregnancy-related complications (uterine weakness, postpartum hemorrhage) was significantly lower than the other (p<0.05). There was no diversity in these two groups in incidence of fetal distress, placental abruption and neonatal asphyxia (p<0.05), both groups incidence of adverse reactions were almost the same and there was no statistical difference (p>0.05). Nifedipine and low molecular weight heparin in patients cure with hypertension during pregnancy can lower blood pressure and reduce the incidence of uterine asthenia, postpartum hemorrhage and other related complications without increasing patient’s incidence of adverse reactions. The medication is meaningful for clinical promotion.

Study protocol for the randomized controlled EVA (early vascular adjustments) trial: tailored treatment of mild hypertension in pregnancy to prevent severe hypertension and preeclampsia

BackgroundIn contrast to severe gestational hypertension, it is questioned whether antihypertensive medication for mild to moderate gestational hypertension prevents adverse maternal and offspring outcomes. Hypertensive drugs halve the risk of severe hypertension, but do not seem to prevent progression to preeclampsia or reduce the risk of complications in offspring. In fact, beta-blockers, a first line therapy option, are suspected to impair foetal growth. Disappointing effects of antihypertensive medication can be anticipated when the pharmacological mode of action does not match the underlying haemodynamic imbalance. Hypertension may result from 1) high cardiac output, low vascular resistance state, in which beta blockade is expected to be most effective, or 2) low cardiac output, high vascular resistance state where dihydropyridine calcium channel blockers or central-acting alpha agonists might be the best corrective medication. In the latter, beta-blockade might be maternally ineffective and even contribute to impaired foetal growth by keeping cardiac output low. We propose a randomized controlled trial to determine whether correcting the haemodynamic imbalance in women with mild to moderate hypertension reduces the development of severe hypertension and/or preeclampsia more than non-pharmacological treatment does, without alleged negative effects on foetal growth.MethodsWomen diagnosed with mild to moderate hypertension without proteinuria or signs of other organ damage before 37 weeks of pregnancy are invited to participate in this randomized controlled trial. Women randomized to the intervention group will be prescribed tailored antihypertensive medication, using a simple diagnostic and treatment algorithm based on the mean arterial pressure/heart rate ratio, which serves as an easy-to-determine proxy for maternal circulatory state. Women randomized to the control group will receive non-pharmacological standard care according to national and international guidelines. In total, 208 women will be randomized in a 1:1 ratio. The primary outcome is progression to severe hypertension and preeclampsia and the secondary outcomes are adverse maternal and neonatal outcomes.DiscussionThis trial will provide evidence of whether tailoring treatment of mild to moderate gestational hypertension to the individual haemodynamic profile prevents maternal disease progression.Trial registrationNCT02531490, registered on 24 August 2015.

Does the Oral Microbiome Play a Role in Hypertensive Pregnancies?

Chronic hypertension during gestation is associated with an increased risk of adverse pregnancy outcomes including pre-eclampsia, fetal growth restriction and preterm birth. Research into new chemotherapeutic regimes for the treatment of hypertension in pregnancy is limited due to concerns about fetal toxicity and teratogenicity, and new therapeutic avenues are being sought in alternative physiological pathways. Historically, generation of the vasodilator nitric oxide was believed to be solely from L-arginine by means of nitric oxide synthase enzymes. Recently, a novel pathway for the reduction of dietary inorganic nitrate to nitrite by the bacteria in the oral cavity and subsequently to vasodilatory nitric oxide within the body has been uncovered. Dietary nitrate is abundant in green leafy vegetables, including beetroot and spinach, and reduction of exogenous nitrate to nitrite by oral bacteria can increase nitric oxide in the vasculature, lessening hypertension. Supplements rich in nitrate may be an attractive choice for treatment due to fewer side effects than drugs that are currently used to treat hypertensive pregnancy disorders. Additionally, manipulation of the composition of the oral microbiota using pro- and prebiotics in tandem with additional dietary interventions to promote cardiovascular health during gestation may offer a safe and effective means of treating hypertensive pregnancy disorders including gestational hypertension and pre-eclampsia. The use of dietary inorganic nitrate as a supplement during pregnancy requires further exploration and large scale studies before it may be considered as part of a treatment regime. The aim of this article is to review the current evidence that oral microbiota plays a role in hypertensive pregnancies and whether it could be manipulated to improve patient outcomes.

Guided imagery for treating hypertension in pregnancy.

Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure. To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies. We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga). Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach. We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22). There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.

228. A qualitative inquiry into women’s preferences for treatment of hypertension in pregnancy

Background National and international clinical practice guidelines recommend two treatment approaches for management of pregnancy hypertension: ‘less tight’ control aiming to minimise antihypertensive therapy, and ‘tight’ control aiming to normalise blood pressure (BP). Consistent with prior small trials, the CHIPS trial (Control of Hypertension In Pregnancy Study) found that ‘tight’ (vs. ‘less tight’) control was associated with lower maternal risk without an increase in perinatal risk. However, treatment choice should reflect both evidence and women’s values, yet, information on the latter is lacking. Objective The study aimed to develop an understanding of what women value when choosing a treatment approach for hypertension in pregnancy. Methods A qualitative approach was used. Semi-structured focus groups and individual interviews were conducted in an iterative fashion, with memoing and debriefing after each group or interview. All interactions were transcribed for thematic analysis grounded in a critical realist perspective. Codes were developed inductively and collected into themes that were reviewed with the research team for face validity. Results Thirteen women participated in two focus groups and five individual interviews. Thematic analysis yielded four themes: - Individualized information. Participants emphasized individualized information and doubted “average” information. - Understanding of pregnancy. Many participants understood pregnancy as a time-limited situation emphasizing infant health during pregnancy and delaying maternal health concerns. - Medication drives preference. Participants varied significantly in willingness to take medication, and desire to avoid medication often drove treatment preference. - Short- vs. long-term risks. Most participants prioritized long-term risks over short-term risks. Additionally, seven attributes were identified as important to consider: likelihood of medication, and caesarean delivery; and risk of severe hypertension throughout pregnancy, preeclampsia, infant being born small for gestational age, and delivery before 34 weeks. Discussion Next steps will be applying these preferences to: (1) determine how patients make trade-offs between attributes; and (2) develop patient-oriented clinical endpoints.

199. Oral antihypertensive treatment of severe hypertension in pregnancy – A randomized trial of 3 regimens

Introduction Management of severe hypertension in pregnancy requires prompt treatment – most commonly with intravenous medications. This strategy presents significant barriers to care, particularly in low resource environments. Objective To compare the effectiveness of three oral antihypertensive regimens in pregnant women with severe hypertension. Methods In an open-labeled trial in two hospitals in Nagpur, India, (NCT01912677), pregnant women ⩾28 weeks’ gestation with sBP ⩾160 mmHg or dBP ⩾110 mmHg were randomized to: (1) nifedipine 10 mg orally repeated hourly up to 2 additional doses for sBP >155 mmHg or dBP >105 mmHg, (2) labetalol 200 mg orally repeated hourly for 2 additional doses as above, or (3) methyldopa 1000 mg as a single dose. The primary outcome was achieving a sBP 120–150 mmHg and dBP 70-100mHg at 6 h without an adverse outcome or fetal compromise. Results 894 women were randomized: nifedipine (n = 298), 83.2% achieved primary outcome, (0.7% required additional drugs); labetalol (n = 295), 77.3% achieved primary outcome, (3.1% required additional drugs); methyldopa (n = 301), 76.4% achieved primary outcome, (18.3% required additional drugs), (NvsMD p = 0.04) X 2 ; (LvsMD p = 0.08), X 2 ; (NvsL p = 0.07) X 2. Without use of additional drugs, nifedipine and labetalol were superior to methyldopa, (P 0.001) X 2. Nifedipine was associated with maternal tachycardia, (p 0.001) X 2 ; persistence of headache, (p = 0.005) X 2 ; and a greater likelihood of neonatal admission to the NICU, (NvsMD p = 0.01) X 2 ; (LvsMD p = 0.6), X 2 ; (NvsL p = 0.06) X 2. MgSO 4 use was limited, 11.7%. The eclampsia rate was 0.1%. There were no maternal deaths or ICU admissions. 96% of infants were born alive; 95% of live-born were alive at discharge. Discussion Each regimen achieved some success. As a single agent, nifedipine and labetalol were superior to methyldopa. A structured approach of measuring BP and intervention with oral medications in a high risk environment achieved low rates of maternal and neonatal complications despite some differences in BP control across groups. This was achieved with a low rate of MgSO 4 utilization.

Management of Chronic and Gestational Hypertension of Pregnancy: A Guide for Primary Care Nurse Practitioners.

Aim:The aim of this discussion paper is to outline the guidelines, according to the American Congress of Obstetricians and Gynecologists, about how to manage hypertension before and during pregnancy. Primary providers lack the knowledge to initiate treatment and manage hypertension in patients who are family planning or in the early stages of pregnancy before transferring care to an obstetrician, or perhaps patients who never do transfer care for lack of accessibility or funding. This paper aims to discuss how the Family Nurse Practitioner, or other primary care providers, may safely and efficiently maintain stable blood pressures in patients with hypertension before, during, and after pregnancy.Background and Implications for Nursing:Clinicians often defer gestational complications to obstetricians, however, it is crucial that there is a basic understanding of how to manage such issues. Primary practitioners do care for these patients during pre-gestation or fertility planning and oftentimes even during pregnancy in underserved communities with little access to obstetrical / prenatal care.Design:Discussion paper of ACOG guidelines and recommendations regarding safe management of hypertension before, during and after pregnancy.Data Sources:Inclusion criteria utilized most current research within the past 5 years, barring one source from the American Heart Association (no more current data) from 2011. This included an examination of current standards of care regarding hypertension during and before pregnancy according to the ACOG. Utilizing keywords such as hypertension, gestational hypertension, pregnancy, pharmacological management of hypertension, ACOG guidelines, treatment of hypertension in pregnancy. The decision to utilize guidelines set forth primarily by ACOG stems from ACOG being the governing body for Obstetricians / Gynecologists. Additionally, “standardization of care improves patient outcomes, which also should translate into a reduction in medical-legal exposure” [2]. As “such guidelines have been developed by specialty organizations such as the American College of Obstetricians and Gynecologists (the college),” ACOG guidelines are nationally utilized in the care of OB/GYN patients.Conclusion:It is essential for primary care clinicians to employ current research regarding hypertension surrounding pregnancy and encourage patients who are family planning to utilize all such data in order to have a healthy and successful pregnancy. In order to do so, thorough practitioners are required to care for patients throughout the spectrum of all health and wellness related situations.

All Hypertensive Disorders of Pregnancy Increase the Risk of Future Cardiovascular Disease.

Hypertensive disorders of pregnancy are associated with vascular dysfunction in the pregnancy and an increased risk of long-term cardiovascular disease (CVD) in the mother. What remains to be understood is whether the length, severity of the disease, the treatment of hypertension in pregnancy, or the subtype of hypertensive disorders of pregnancy are significant predictors of future CVD. We undertook a retrospective cohort study to review all women who gave birth at a tertiary hospital in Sydney between the years 1980 and 1989 (n=31 656). A cohort of women was further defined by having hypertension during the antenatal, intrapartum, or postnatal periods (n=4387). Randomly selected records of women (n=1158) with a hypertensive disorder of pregnancy were individually reviewed to collect data on their pregnancy and pregnancy outcomes. The entire cohort then underwent linkage analysis to future CVDs. Women who presented with gestational hypertension were at greater risk of future hypertension and ischemic heart disease compared with the women who were diagnosed with preeclampsia. There was no significant difference between the women who were treated with antihypertensive medication and the women who did not receive antihypertensive medication or the duration of hypertensive disorders of pregnancy and future admission for CVD, although severity of hypertension tracked with increased risk of future hypertension in all groups. This study demonstrated that all women who present with any of the subtypes of hypertensive disorders in pregnancy are at significant risk of future CVD compared with women who remain normotensive during their pregnancy.

Controversies Regarding Diagnosis and Treatment of Severe Hypertension in Pregnancy.

The objective of management of severe hypertension in pregnancy is not for the return of normal blood pressure but rather reduction of blood pressure to a level associated with a decreased risk of end-organ damage including cerebral, cardiac, or renal dysfunction. The parenteral agents labetalol and hydralazine are currently the most widely recommended antihypertensive agents for acute reductions of elevated blood pressure related to preeclampsia. Overcorrection of blood pressure with any antihypertensive agent is possible resulting in reduced uteroplacental blood flow, but is more likely to be encountered in patients <32 weeks' gestation and in those whose fetuses have intrauterine growth retardation.

22 The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy

Introduction Labetalol and modified release (MR) nifedipine are recommended for the treatment of hypertension in pregnancy. However, there is limited data on the blood pressure (BP) lowering effects of these drugs in the pregnant population. Objectives To determine and compare the effects of labetalol and nifedipine MR on the systolic (S) and diastolic (D) BP in a high-risk pregnant cohort. Methods Pregnant women already prescribed labetalol or nifedipine MR for chronic hypertension were offered 24-h ambulatory blood pressure monitoring (ABPM). The pre-dose BP was taken as baseline. The BP was measured every 30 min between 8 am and 10 pm. The time of drug ingestion was self-reported. For labetalol, the BP time series data were binned into quartiles; 0–25th (0–2.5 h(h)), 25th–50th (2.5–4 h), 50th–75th (4–6.4 h) and 75th–100th (6.4-end). For nifedipine the quartiles represented the following times post drug ingestion: 0–3 h, 3–5.7 h, 5.7–8.5 h and 8.5-end respectively. A statistical model was fitted to investigate the drug effect on systolic and diastolic BP: BP(t) = BP(0)∗exp(−d∗t) + g∗t where d was the drug effect which decays over time and g was the change in BP as a function of time. Results Data was available for 41 women; labetalol n = 22 and nifedipine n = 19. In the labetalol group the median total daily dose was 400 mg (IQR: 300–600 mg). In the nifedipine group the median total daily dose was 35 mg (IQR: 20–55 mg). The median gestation was 175 days (IQR: 112–188) for labetalol and 162 days (126–219) for nifedipine. Baseline SBP and DBP was different between the 2 groups p-value Labetalol ingestion resulted in an initial drop followed by a rebound rise in SBP and DBP, with the BP returning to the baseline at the 75th–100th time point. When the final time-bin was analysed separately according to total daily dose (≤400 mg and In the nifedipine group the time series data suggested that there was minimal change from the baseline SBP, there was a slight drop in DBP at early time points. When the BP time series data for labetalol was compared to Nifedipine (Fig. 1) the difference in the decrease and increase in SBP was statistically significant, p Download : Download high-res image (129KB) Download : Download full-size image Conclusion This exploratory study has identified differences in the efficacy of commonly prescribed agents used for the treatment of chronic hypertension in pregnancy. As previously reported, labetalol has a relatively fast onset of action with a BP lowering effect seen within 2.5 h. The duration of effect however is short and often followed by a rebound increase. A more sustained effect was observed with nifedipine, although in this study the baseline BP was higher in this group. Further research is required to establish if the different effects on BP at different gestations impact on maternal and fetal outcome.

9 Pregnancy and chronic hypertension: Nifedipine vs labetalol as antihypertensive treatment (the panda study)

Introduction Chronic hypertension complicates around 3% of all pregnancies and is associated with adverse maternal and perinatal outcome. The optimal antihypertensive treatment(s) for pregnancy complicated by chronic hypertension is uncertain. Choice of antihypertensive outside pregnancy depends on ethnicity. It is unclear if ethnicity impacts on the efficacy of antihypertensive treatment during pregnancy. Objectives To perform a feasibility study to inform a randomised controlled trial in women with chronic hypertension in pregnancy, comparing nifedipine and labetalol for control of chronic hypertension in pregnancy, with additional assessment of the impact of ethnicity on efficacy of each treatment. Method Pregnant women with chronic hypertension were enrolled between August 2014 and October 2015 at four UK centres, with the last woman delivering in April 2016. Participants were randomised to nifedipine or labetalol as antihypertensive treatment between 12+0 and 27+6 weeks' gestation using a minimisation protocol. Demographic, serial longitudinal antenatal blood pressure readings, and maternal/perinatal outcome data were collected and analysed. Results 114 women were randomised to antihypertensive treatment (67% of those screened and eligible). Average monthly recruitment varied from 1.2 to 3.7 participants per centre. 54% ( n =62) of those recruited were of black ethnicity. 98% ( n =112) completed the study (1 withdrawal, 1 lost to follow-up). 12 participants (10.5%) (five in the nifedipine arm and seven in the labetalol arm) discontinued their assigned intervention due to side effects of the treatment and switched to alternative medication. Four women (3.6%) had a second trimester miscarriage and two women (1.8%) underwent termination of pregnancy (one with superimposed pre-eclampsia at 16 weeks' gestation and one with a fetus with sickle cell disease on amniocentesis). Of the women whose pregnancies continued beyond 24 weeks' gestation, 25% ( n =27) were diagnosed with superimposed pre-eclampsia; 27% ( n =29) of babies were delivered before 37 weeks' gestation, 35% ( n =38) of birthweights were less than the 10th percentile, 17% ( n =20) of birthweights were less than the 3rd percentile and there were two stillbirths (1.9%). Conclusion This study confirms good recruitment to a trial comparing commonly used antihypertensive agents for the treatment of chronic hypertension in pregnancy. In addition, the high incidence of adverse maternal and perinatal outcomes is highlighted within this cohort. Further exploration of the antenatal blood pressure profiles and maternal/perinatal outcomes within each treatment group is planned to assess efficacy.

Assessment of Prescribing Patterns of Antihypertensive Used in the Treatment of Hypertension in Pregnancy in a Teaching Hospital

INTRODUCTION : Hypertension occurs in 5% to 10% of pregnancies, though information on the safety of antihypertensive medication use during pregnancy is limited. Anti-hypertensive medications are used to prevent serious maternal and fetal complications , however there is no consensus on when to treat mild-to-moderate hypertension. Although treatment with medication might benefit the mother, it carries potential risk to the fetus. The study of prescribing pattern is a component of medical audit which seeks monitoring, evaluation and necessary modifications in the prescribing practices of the prescribers to achieve rational and cost effective medical care. The present study was undertaken to assess the prescription pattern of antihypertensive used in the treatment of hypertension in pregnancy at a tertiary care hospital. OBJECTIVE&METHODOLOGY :A hospital based prospective study was conducted for a period of 9 months at Basaveshwar teaching and general hospital with an objective of analyzing prescription pattern of antihypertensive among pregnant women. Hypertensive patients were enrolled by considering study criteria. Required data was collected in a suitably designed data collection. RESULTS : A total of 155 pregnant women were enrolled in the study, among them 55(35.5%) pregnant women were in the age group of 23-27. Majority of pregnant woman had mild hypertension. Pharmacotherapy revealed that out of 155 patients 102(65.8%) patients were treated with monotherapy, followed by 53 (34.19%) combination therapy. Nifedipine was the drug of choice in monotherapy while the combination of methyldopa and labetalol was the most preferred combination therapy. For eclamptic patients the combination therapy of magnesium sulphate+ methyldopa+ labetalol was preferred. CONCLUSION : The study concludes that, their no standard approach to treat hypertension in pregnany. Prescribers are not following guidelines like NISE, Midwives, State-wide, JNC and NHBPEP nor they have their own set of guidelines lines .The treatment guidelines can be established by the hospital in collaboration with clinical pharmacist that may be useful tool for the effective management of the hypertension in pregnancy.

Treating Hypertension in Pregnancy.

Hypertension is present in about 10 % of all pregnancies. The frequency of chronic hypertension and that of gestational hypertension is increasing. The management of pregnant women with hypertension remains a significant, but controversial, public health problem. Although treatment of hypertension in pregnancy has shown to reduce maternal target organ damage, considerable debate remains concerning treatment. We review current evidence regarding treatment goals, the ideal treatment starting time, and which drugs are available for the treatment of hypertension in pregnancy.