title: Randomised controlled trial of atenolol and pindolol in human pregnancy: effects on fetal haemodynamics. Calcium channel blockade (isradipine) in treatment of hypertension in pregnancy: a randomized placebo-controlled study. FINAL REPORT OF STUDY ON HYPERTENSION DURING PREGNANCY: THE EFFECTS OF SPECIFIC TREATMENT ON THE GROWTH AND DEVELOPMENT OF THE CHILDREN Antihypertensive treatment in pregnancy: analysis of different responses to oxprenolol and methyldopa. Effect of methyldopa and isradipine on fetal heart rate pattern assessed by computerized cardiotocography in human pregnancy. Calcium Dobesilate Lowers the Blood Pressure in Mild to Moderate Midtrimester Hypertension Hypertension during pregnancy, with and without specific hypotensive treatment. I. Perinatal factors and neonatal morbidity. [Acebutolol in the treatment of arterial hypertension in pregnancy--comparison with commonly used hypertensive agents]. Atenolol in essential hypertension during pregnancy. Indoramin in the treatment of pregnancy hypertension. A placebo-controlled trial comparing the efficacy of indoramin with alpha-methyldopa. Preeclampsia: haemostatic status and the short-term effects of methyldopa and isradipine therapy. Labetalol vs. methyldopa in the treatment of pregnancy-induced hypertension. Treatment of hypertension in pregnancy with methyldopa: a randomized double blind study. [Nifedipine in preeclampsia for cesarean section]. The effect of sublingual nifedipine on uteroplacental blood flow in hypertensive pregnancy Maternal and fetal haemodynamics in hypertensive pregnancies during maternal treatment with intravenous hydralazine or labetalol PLACEBO-CONTROLLED TRIAL OF ATENOLOL IN TREATMENT OF PREGNANCY-ASSOCIATED HYPERTENSION The effect of nifedipine on fetal umbilical artery Doppler waveforms in pregnancies complicated by hypertension. Magnesium supplement in pregnancy-induced hypertension: effects on maternal and neonatal magnesium and calcium homeostasis. Comparison of outcome of labetalol or hydralazine therapy during hypertension in pregnancy in very low birth weight infants Beta-adrenergic blocking agents in the treatment of pregnancy-induced hypertension. Obstetric aspects of the use in pregnancy-associated hypertension of the beta-adrenoceptor antagonist atenolol. Propranolol in pregnancy three year prospective study. The Effect of Prophylactic Management and Therapeutics on Hypertensive Disease in Pregnancy: Preliminary Studies [Atenolol and bisoprolol in the treatment of mild and moderately severe hypertension]. The effect of nifedipine on urinary excretion of calcium in preeclampsia. Flow velocity analysis of umbilical and uterine artery flow in pre-eclampsia treated with propranolol or pindolol. [The effect of nimodipine on retinal blood flow in pregnancy induced hypertension]. Effect of calcium channel blocker nifedipine on uterine artery flow velocity waveforms. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. HYPERTENSION DURING PREGNANCY WITH AND WITHOUT SPECIFIC TREATMENT; THE DEVELOPMENT OF THE CHILDREN AT THE AGE OF FOUR YEARS A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term. A PROSPECTIVE CONTROLLED TRIAL OF METOPROLOL‐HYDRALAZINE TREATMENT IN HYPERTENSION DURING PREGNANCY Evaluation of calcium-antagonist (Nifedipine) in the treatment of pre-eclampsia. [Clinical observation on therapeutical effect of prepared rhubarb in treating pregnancy induced hypertension]. Magnesium supplement in pregnancy‐induced hypertension TREATMENT OF HYPERTENSION IN PREGNANCY WITH METHYLDOPA: BLOOD PRESSURE CONTROL AND SIDE EFFECTS Treatment of hypertension during pregnancy with hydralazine monotherapy or with combined therapy with hydralazine and pindolol. Nifedipine versus expectant management in mild to moderate hypertension in pregnancy A randomized comparison of early with conservative use of antihypertensive drugs in the management of pregnancy‐induced hypertension Randomised controlled trial of methyldopa and isradipine in preeclampsia – effects on uteroplacental and fetal hemodynamics [The effect of Nifedipine on postpartum blood loss in patients with pregnancy induced hypertension]. The effect of nitric oxide on uterine and umbilical artery flow velocity waveform in pre-eclampsia. The Effect of Oral Ketanserin on Fetal Heart Rate Parameters. Comparison of the alpha and beta blocking drug, labetalol, and methyl dopa in the treatment of moderate and severe pregnancy-induced hypertension. Does labetalol influence the development of proteinuria in pregnancy hypertension? A randomised controlled study. A comparison of nifedipine with methyldopa in pregnancy induced hypertension. The measuring of blood pressure during pregnancy. Nicardipine Versus Metoprolol in the Treatment of Hypertension During Pregnancy: A Randomized Comparative Trial A comparative evaluation of metoprolol and methyldopa in the management of pregnancy induced hypertension. Methyldopa versus no drug treatment in the management of mild pre-eclampsia. Randomised controlled comparative study of methyldopa and oxprenolol in treatment of hypertension in pregnancy. 24-hour ambulatory blood pressure monitoring: a comparison between transdermal glyceryl-trinitrate and oral nifedipine. EFFECT OF ANTIHYPERTENSIVE DRUGS ON NEONATAL BLOOD PRESSURE Comparison of Magnesium and Methyldopa for the Control of Blood Pressure in Pregnancies Complicated with Hypertension Hypertension during pregnancy, with and without specific hypotensive treatment. II. The growth and development of the infant in the first year of life. Clonidine Hydrochloride—A Safe and Effective Antihypertensive Agent in Pregnancy Neonatal Effects of Beta‐Blocking Drugs in Pregnancy Ketanserin versus alpha-methyldopa in the treatment of hypertension during pregnancy: a preliminary report. Blood pressure patterns in pregnant patients on oral ketanserin. Intrauterine exposure to the beta-adrenergic receptor-blocking agent metoprolol and allergy. FETAL OUTCOME IN TRIAL OF ANTIHYPERTENSIVE TREATMENT IN PREGNANCY A randomised placebo controlled trial of labetalol in the treatment of mild to moderate pregnancy induced hypertension First year of life after the use of atenolol in pregnancy associated hypertension. Nifedipine administered in pregnancy: effect on the development of children at 18 months Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia The effect of magnesium on maternal blood pressure in pregnancy‐induced hypertension A randomized double‐blind placebo‐controlled trial Uterine and fetal hemodynamics and fetal cardiac function after atenolol and pindolol infusion. A randomized study. NEONATAL HEAD CIRCUMFERENCE AND THE TREATMENT OF MATERNAL HYPERTENSION Early blood pressure control improves pregnancy outcome in primigravid women with mild hypertension. Management of pregnancy-induced hypertension with pindolol--comparative study with methyldopa. A controlled trial of hypotensive agents in hypertension in pregnancy. Randomised comparison of methyldopa and oxprenolol for treatment of hypertension in pregnancy.
abstract: OBJECTIVE --To compare the effects of uteroplacental circulation of two beta adrenoceptor blockers , atenolol ( cardioselective ) and pindolol ( non-selective with intrinsic sympathomimetic activity ) . DESIGN --Controlled double blind double dummy study . SETTING --Departments of obstetrics and gynaecology in two Swedish university hospitals . SUBJECTS--29 women with pregnancy induced hypertension in the third trimester , 13 r and omised to atenolol and 16 to pindolol .  MAIN OUTCOME MEASURES --Pulsatility index in fetal aorta , umbilical artery , and maternal arcuate artery . Volumetric blood flow in fetal aorta and umbilical vein . RESULTS --Mean arterial blood pressure decreased by 9.0 ( 95 % confidence interval -13.0 to -5.0 ) mm Hg in the atenolol group and by 7.8 ( -11.4 to -4.2 ) mm Hg in the pindolol group . During atenolol treatment the pulsatility index increased significantly from 1.82 ( SD 0.20 ) to 2.07 ( 0.32 ) in the fetal thoracic descending aorta , from 1.44 ( 0.28 ) to 1.79 ( 0.27 ) in the abdominal aorta , and from 0.93 ( 0.17 ) to 1.05 ( 0.19 ) in the umbilical artery ; the volumetric blood flow in the umbilical vein decreased from 106 ( 28.8 ) to 84 ( 22.6 ) ml/min/kg . No such changes were seen after treatment with pindolol . Birth weight was similar in the two groups but placental weight was significantly different ( 529 ( 122 ) g in atenolol group v 653 ( 136 ) g in pindolol group ; p = 0.03 ) . CONCLUSION --The hypotensive effect was similar with both drugs , but only the beta 1 blocker atenolol had significant effects on fetal haemodynamics , although within normal ranges . The implication s of these findings can be only speculative , but negative fetal consequences of beta 1 adrenoceptor blockade can not be excluded OBJECTIVE Our purpose was to study the effects of isradipine , a dihydropyridine calcium channel blocker , on mother and fetus in the treatment of hypertensive disorders of pregnancy . STUDY DESIGN The investigation was performed as a two-group , parallel , double-blind multicenter study of isradipine versus placebo .  Fifty-four women were r and omized to treatment with isradipine slow-release capsules given orally 5 mg twice a day and 57 to a  placebo group . RESULTS Isradipine lowered the maternal mean arterial blood pressure effectively in women with nonproteinuric hypertension but did not do so in women with proteinuria at recruitment or appearing during treatment . Blood flow in the umbilical artery and maternal renal and liver function were not influenced by treatment . Isradipine had few side effects and was well tolerated . CONCLUSION Calcium channel blockade with isradipine is effective for treatment of nonproteinuric hypertension but not in preeclampsia 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 h and icap , 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 st and ing 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 One hundred and eighty three hypertensive pregnant women were r and omly assigned to antihypertensive treatment with oxprenolol ( 96 women ) or methyldopa ( 87 women ) . Control of hypertension was equivalent in both treatment groups , and in 64 ( 35 % ) cases hydralazine had to be added to the treatment to achieve the therapeutic goal ( diastolic blood pressure below 85 mm Hg ) . Five perinatal deaths occurred , one in the oxprenolol group and four in the methyldopa group . Detailed analysis confirmed a previous report of greater fetal growth in the group treated with oxprenolol ; this trend was present regardless of severity of hypertension and parity . With increasing duration of treatment the differences between the two groups diminished , and there was no difference after 10 weeks of treatment , a finding that may explain some of the reported discrepancies among therapeutic studies . As hypertension in pregnancy may pursue an accelerated course , necessitating urgent delivery , and there is no satisfactory method of predicting the duration of treatment in individual patients fetal benefit is most likely to be achieved by treatment with oxprenolol , provided that there is no maternal contraindication to treatment with beta blockers OBJECTIVE The effects of two antihypertensive drugs , methyldopa and isradipine , on fetal heart rate pattern were analyzed by computerized cardiotocography . STUDY DESIGN The first part of the study was a prospect i ve , r and omized , controlled trial of 19 women with preeclampsia in the third trimester given 2.5 mg of oral slow-release isradipine twice a day or 250 mg of methyldopa three times a day . In a second part of the study 23 women with preeclampsia in the third trimester given 5 mg of oral slow-release isradipine twice a day were compared with 23 matched controls without medication . Main outcome measures were maternal blood pressure and mean baseline fetal heart rate , fetal movements , number of accelerations , periods of high and low baseline variability , and mean baseline heart rate variability . RESULTS Compared with the pretreatment value , the mean arterial blood pressure decreased significantly in all drug treatment groups . Fetal heart rate characteristics were not significantly changed during drug treatment or bed rest . CONCLUSION The various features of the fetal heart rate pattern evaluated by computerized methods were not influenced by treatment with methyldopa or isradipine To test the effects of calcium dobesilate ( Doxium ) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind , placebo-controlled pilot study was carried out . Primigravida patients ( gestational age ≤34 weeks ) daily took 2 g Doxium or placebo until delivery . Twelve patients received placebo for 53 days , and 11 patients took the drug for 57 days on average . At the start of the study 2 patients in the placebo group ( PG ) and 8 in the Doxium group ( DG ) had pre-eclampsia . The mean arterial pressure ( mean ± SD ) significantly decreased from 118 ± 7 to 99 ± 9 mm Hg in the DG ( p = 0.003 ) , while in the PG it had slightly increased by the end of the study . Proteinuria was higher in the DG at the start but not at the end ; however , significant changes of this parameter were detected in neither of the groups throughout the study . Fibronectin decreased significantly in both groups but it was more pronounced in the DG ( 23.8 vs. 9.4 % ) . Changes of platelet count , plasma and blood viscosity , and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant . No marked differences were found between the two groups regarding fetal well-being , courses of deliveries , and the neonatal period . Neither maternal nor fetal/neonatal side effects were noticed . It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension In a prospect i ve study , women who were hypertensive before the 28th wk of gestation were r and omly allocated into two groups : those who received specific hypotensive therapy ( Ht )  and those who did not ( Hu ) . The outcome was compared with a r and om sample of the hospital population ( S ) ascertained after delivery . In both hypertensive groups there was a higher incidence of clinical signs of possible fetal distress and instrumental delivery . Although there was no difference between the groups in the distribution of birthweight above and below the mean for gestational age , the treated hypertensive group had an excess of infants with relatively smaller head circumferences for their gestational age compared with both the untreated hypertensive group and the hospital sample . Tube-feeding was also more frequent in the treated hypertensive group . In the untreated hypertensive group there were more infants whose neurological status was categorized as question able or abnormal in the neonatal period , compared with the sample . The different problems encountered by infants in the two hypertensive groups emphasized the need for further study of these babies . Their development during the first year of life will be examined in a subsequent paper OBJECTIVE The main purpose of our study was to analyse efficacy and safety of acebutolol ( Sectral ) in the treatment of hypertension in pregnancy . DESIGN Cohort clinical study comparing efficacy and safety of acebutolol with other antihypertensive drugs by 77 patients and their 81 newborns . The number of 48 patients were treated by acebutolol .  SETTING Internal Medicine and Clinical Pharmacology Department , Regional Hospital , Nitra and The Faculty of Health Service and Social Work , University of Trnava ; Department of Gynaecology and Obstetrics , Regional Hospital Nitra and The Faculty of Health Service and Social Work , University of Trnava ; Institute of Pharmacology , The Faculty of Medicine , Komenského University , Bratislava ; Environment , a.s . Nitra . METHODS During the period of 6 years our patients were divided into subgroups according to the type of hypertension in pregnancy and the severity of the illness which was the basis for used antihypertensive drugs . One of the topics of the study was to provide monitoring of adverse events by mother and possible drug influence on their new-born has been evaluated by investigating the week of birth , weight and length of the new-born and evaluating of Apgar score . RESULTS In the subgroup of 48 women treated by acebutolol we have confirmed the efficacy and safety of this antihypertensive drug without any clinical ly significant effect on the quality of life of their new-born and evaluating of Apgar score . CONCLUSION With regard to the results of our clinical study we can consider acebutolol to be effective and safe antihypertensive drug in the treatment of hypertension in pregnancy OBJECTIVE --To determine the effect of atenolol on the outcome of pregnancy in women with essential hypertension . DESIGN -- Prospect i ve , r and omised , double blind , placebo controlled study . SETTING --Hospital clinic . PATIENTS --33 Women with mild essential hypertension ( systolic blood pressure 140 - 170 mm Hg or diastolic pressure 90 - 110 mm Hg on two occasions at least 24 hours apart ) consecutively referred to two obstetric medical clinics . Four patients in the  placebo group were withdrawn from the study : control of blood pressure was inadequate in two , one developed breathlessness , and one changed her mind about participating . The mean gestation in the 29 remaining women on entry to the study was 15.9 weeks . MAIN OUTCOME MEASURES --Blood pressure and birth weight . INTERVENTION--14 Women received placebo . 15 Women received atenolol 50 mg daily initially , increasing until either the blood pressure was less than 140/90 mm Hg or a dose of 200 micrograms daily was reached . RESULTS --The mean blood pressure on entry was 148/86 mm Hg in the group given atenolol and 144/86 mm Hg in the group given placebo . During treatment the mean diastolic pressure was significantly reduced by atenolol compared with placebo ( to 74 v 81 mm Hg ; difference in means ( 95 % confidence interval ) 7.0 ( 2.9 to 10.0 ) mm Hg ) but the effect on systolic pressure was marginal ( 132 v 136 mm Hg ; 4.0 ( -1.4 to 8.6 ) mm Hg ) . Babies in the atenolol group had a significantly lower birth weight than those in the placebo group ( 2620 g v 3530 g ; 910 ( 440 to 1380)g ) . CONCLUSION --Atenolol given from the end of the first trimester in patients with mild hypertension is associated with intrauterine growth retardation . When taken in conjunction with the results of a previous study in which methyldopa was given these findings indicate that benefit is unlikely to result from treating mild essential hypertension in pregnancy A placebo-controlled trial was used to assess the antihypertensive efficacy of indoramin in the management of  pregnancy hypertension . Sixty patients were recruited into the study and only 17 attained satisfactory blood pressure control .  In the doses of drugs administered indoramin was not shown to be more effective than alpha-methyldopa OBJECTIVE To determine the haemostatic status in preeclampsia and to investigate the effects of short-term use of anti-hypertensive drugs , methyldopa and isradipine . METHODS Thirty preeclamptic ( PE ) women admitted to the hospital for observation and treatment were r and omized to receive either methyldopa or isradipine for 2 weeks . Their blood pressure were monitored for 24 h before treatment and again at 7 days and 14 days after treatment using the programmable automated ambulatory blood pressure ( ABP ) monitoring system . Blood sampling was performed before commencement of anti-hypertensive treatment , 7 days and 14 days after treatment and the haemostatic parameters studied was compared before treatment with normal pregnancy and the effect of anti-hypertensive treatment . Nineteen normal pregnant subjects with a total of 30 blood sampling at various gestation and good pregnancy outcome served as controls . The following haemostatic parameters were determined ; thrombelastography , fibrinogen , antithrombin III ( ATIII ) , thrombin-antithrombin (TAT)-complex , beta-thromboglobulin ( beta-TG ) , plasminogen activators ( t-PA , u-PA ) , plasminogen activator inhibitors ( PAI-1 , PAI-2 ) , and plasminogen . RESULTS Significant lowering of blood pressure was evident at Days 7 and 14 of therapy with either methyldopa or isradipine . Increased mean plasma fibrinogen and decreased ATIII levels were seen in preeclampsia together with decreased u-PA and t-PA activity levels in contrast to increased t-PA antigen and beta-TG . No significant differences were seen for TAT-complex , PAI-1 , plasminogen and D-dimer levels although their mean levels were higher than observed in non-pregnant subject except for PAI-2 , the level was significantly reduced when compared with normal pregnancy . Two-way analysis of variance showed no significant alteration on all haemostatic parameters studied in preeclamptic women receiving either methyldopa or isradipine after 7 and 14 days of therapy . CONCLUSION Enhance activation of coagulation was observed together with raised fibrinolysis in normal pregnancy and PE . However , in PE a further reduction in ATIII , u-PA and PAI-2 with increased fibrinogen and platelet activation could lead to an imbalance in the coagulation/fibrinolysis equilibrium which favours fibrin deposition . All these changes seen in PE including the coagulation kinetics were not altered by the short term effects of methyldopa and isradipine even though significantly lowered blood pressure were observed during therapy OBJECTIVE To assess the efficacy and safety of labetalol compared with methyldopa in the management of mild and moderate cases of pregnancy-induced hypertension ( PIH ) . METHODS One hundred four primigravidas with PIH were r and omly allocated to receive either labetalol ( group A ) or methyldopa ( group B ) . The dose of the drugs was doubled every 48 h to maintain a mean arterial blood pressure < or = 103.6 mmHg . Clinico-biochemical effects and frequency of side effects were studied . The statistical level of significance was taken at P < 0.05 . RESULTS Ten patients in group B ( 18.5 % ) developed significant proteinuria ( > 30 mg/dl ) whereas none developed proteinuria in group A. Labetalol was quicker and more efficient at controlling blood pressure , having a beneficial effect on renal functions and causing fewer side effects compared with methyldopa . The rate of induction of labor and rate of cesarean section for uncontrolled PIH was less in group A ( 48 % and 1 % , respectively ) compared with group B ( 63.0 % and 5.6 % , respectively ) . Moreover a higher Bishop score at induction of labor was noticed in group A. CONCLUSIONS Labetalol is better tolerated than methyldopa , gives more efficient control of blood pressure and may have a ripening effect on the uterine cervix Twenty-five patients whose pregnancies were complicated by chronic hypertension were entered in a double-blind study and r and omly allocated to treatment with methyldopa ( Aldomet ) or placebo .  Thirteen patients were in the treatment group and 12 in the placebo group . The two groups showed no significant difference in demographic and pretreatment laboratory profiles . Methyldopa-treated patients registering in the first trimester had a significant reduction in the mean arterial pressure ( MAP ) during the second and third trimesters ( P less than 0.025 ) . No significant differences in birth weight ( BW ) , ponderal index ( PI ) were found when results were corrected for gestational age ( GA ) , race , and sex . The mean GA was significantly prolonged in the methyldopa-treated group by 10.3 days ( P less than 0.05 ) . The frequency of superimposed pre-eclampsia was similar in both groups ( 33.3 % vs. 38.4 % ) . However , 75 % of the superimposed pre-eclampsia occurred antepartum in the placebo group , while 80 % of the methyldopa-treated group developed superimposed pre-eclampsia intrapartum . The results of this small study suggest that the treatment of hypertension in pregnancy may reduce MAP and possibly delay the occurrence of superimposed pre-eclampsia and thus afford a prolongation of the pregnancy The patients with preeclampsia undergoing emergent cesarean section is always a challenge to an anesthesiologist , because severe hypertensive response after laryngoscopy and tracheal intubation may result in life-threatening complication such as cerebral hemorrhage . Most of these patients receive magnesium sulfate for the prevention of convulsion . An ideal anti-hypertensive drug for preeclampsia should be effective , limited fall in blood pressure , rapid onset , maintaining uteroplacental blood flow , and less maternal and fetal side effects . We studied the efficacy of 10 mg sublingual nifedipine in attenuating the pressor response to intubation . We were also concerned about whether this calcium antagonist may inhibit uterine contraction and increase intra and postpartum hemorrhage when it is used with magnesium sulfate and general anesthesia . There were thirty-three patients in our study ( 16 in nifedipine group and 17 in control group ) . This study revealed that nifedipine attenuate the hypertensive response effectively . Uterine contraction response to oxytocic drugs was quite well in both groups . There was no significant difference in blood loss between nifedipine and control group . And no severe maternal and fetal adverse effect Summary . The effect of nifedipine on uteroplacental blood flow was investigated in nine hypertensive women in the third trimester of pregnancy and compared with the effects of a placebo in nine similar hypertensive women . An index of uteroplacental blood flow was obtained , twice before treatment and once after treatment , by measuring the increase in radioactivity in the region of the placenta with a gamma camera following an intravenous injection of indium‐113 m . There was no significant change in the blood flow index in either the nifedipine‐ or the placebo‐treated groups despite a significant fall in blood pressure with nifedipine . Nifedipine lowers the blood pressure without any apparent reduction in uteroplacental blood flow Summary . Intravenous treatment with 10 mg of hydralazine or 100 mg of labetalol was r and omly allocated to 30 hypertensive pregnant women .  Umbilical artery flow velocity waveforms were recorded using a pulsed Doppler duplex scanner ( ATL Mk V ) and umbilical artery pulsatility index ( PI ) and fetal heart rate ( FHR ) were derived from these recordings . Maternal blood pressure decreased significantly after both drugs . Maternal pulse rate increased after hydralazine but did not change significantly after labetalol . FHR did not change significantly after hydralazine but decreased after labetalol . PI decreased after hydralazine and increased after labetalol‐most fetuses showed little change but a few in each group showed large changes in PI , as did two of five additional patients studied . We attributed the decrease in PI in some fetuses after hydralazine to vasodilation , and the increase in PI in some fetuses after labetalol to vasoconstriction in the fetoplacental circulation , suggesting that fetal beta‐blockade may occur after maternal treatment with labetalol Atenolol was compared with placebo in a r and omised and double-blind prospect i ve study of 120 women with mild to moderate pregnancy-associated hypertension who were also initially managed conventionally by bed rest .  Atenolol given once daily significantly reduced blood-pressure , prevented proteinuria , and reduced the number of hospital admissions . Loss of blood-pressure control leading to withdrawal from the study was commoner among the placebo group , whose babies had a high morbidity . Respiratory distress syndrome occurred only in the placebo group . Intrauterine growth retardation , neonatal hypoglycaemia , and hyperbilirubinaemia occurred with the same frequency in the two groups . Neonatal bradycardia was more common after atenolol but the systolic blood-pressure of the babies was the same in both groups . There was no difference between the groups in maternal symptoms which could have been attributed to beta-blocker therapy . Thus atenolol is more effective than conventional obstetric management in this form of hypertension and does not adversely affect mother or baby The effect of nifedipine 5 mg administered sublingually to pregnant hypertensive patients was examined in a r and omised controlled double-blind study . The effect on maternal blood pressure and the fetal umbilical artery Doppler waveform was studied for 30 minutes before and 30 minutes after administration of the drug or placebo . This dose result ed in a significant drop in maternal blood pressure 30 minutes after administration and did not result in a significant change in the Doppler umbilical artery waveform ( in fetuses with normal waveforms ) when compared with a control group The objective of this study was to evaluate the effect of low dose magnesium supplement upon maternal and fetal serum levels of mineral status in pregnancies complicated with hypertension ( PIH ) . Twenty-five patients with PIH agreed to participate and were r and omly allocated , in a double-blind manner , either to intravenous magnesium for 2 days followed by oral magnesium ( n = 12 ) until delivery or placebo ( n = 13 ) . In women supplemented with magnesium the level of magnesium increased from 0.74 to 1.02 mmol/l during the first 24 h of inclusion and simultaneously we observed an increased urinary loss of magnesium . Serum level and the urinary excretion of magnesium returned to pretreatment level at delivery . Maternal magnesium supplement increased the concentrations of magnesium in umbilical cord and neonatal blood 1 day after delivery . Serum ionized calcium did not change during the study period despite a significant increased loss of calcium during the first 24 h of inclusion . Low dose maternal magnesium treatment did not cause neonatal hypocalcemia Ninety‐seven women with moderate to severe preeclampsia ( PE ) were allocated at r and om to labetalol or hydralazine treatment . Of these , 22 women with severe PE gave birth to neonates with VLBW ( very low birth weight ≥ 1500 g ) . Seven were allocated to labetalol treatment ( Group A ) , eight to hydralazine treatment ( Group B ) and seven women received both drugs due to poor blood pressure control with a single drug therapy ( Group C ) . No difference in cesarean section rate or in the indication for operative delivery could be seen . Gestational age was 29.9 weeks ( 25.4–32.5 ) in Group A. 28.6 weeks ( 26.6–33.4 ) in Group B and 27.3 weeks ( 26.7–31.1 ) in Group C  (  median and range ) . Birth weight did not differ between groups and 13 of the 22 infants weighed below 1000 g. There was a tendency to lower Apgar scores at five minutes in the hydralazine group . Time spent in the neonatal intensive care unit did not differ between groups . Five of the 11 neonates with gestational age (GA)≥28 weeks and three of the seven neonates in GA 29–30 weeks died . Neither the number of infants requiring intermittent positive pressure ventilation or duration of O2‐treatment , nor number of infants with respiratory distress syndrome differed between groups . We did not find any difference in the outcome of the VLBW infants when the hypertensive mother had been treated with either hydralazine or labetalol Fifty-one women with pregnancy-induced hypertension ( PIH ) were r and omly allocated to one of three treatment groups : A : hydralazine ( 13 ) ; B : hydralazine and propranolol ( 17 ) ; and C : hydralazine and pindolol ( 19 ) . All women fulfilled the pretreatment criteria and were of similar age , numbers of previous pregnancies and had systolic blood pressure ( SBP ) of between 140 and 160 mmHg and diastolic blood pressure ( DBP ) of between 95 and 110 mmHg .  Hypertension was treated equally well by all three regimens ( mean SBP was 133.6 , 130 and 134 mmHg , respectively ) . Heart rate was significantly higher than baseline in group A and lower in groups B and C , as is to be expected with beta-blocker treatment . Side-effects were more frequent in group A than in groups B and C , 62 % of the patients on hydralazine monotherapy complained of palpitations compared to 35 % on combination treatment . Fetal outcome differed in the various groups . Birth weight was significantly lower in group B , where regimen included propranolol , compared to that of group C , for whom the regimen included pindolol ( 3,044.7 + /- 443.8 and 2,709.6 + /- 485.5 gm , p < 0.05 ) . Mean blood glucose of the newborns were similar in groups A and C ( 76.5 + /- 16.5 and 78.6 + /- 15 gm% ) and significantly lower in group B ( 62.6 + /- 14 gm% , p < 0.02 ) . In conclusion , blood pressure was equally well treated in all three treatment groups . However , more maternal side-effects occurred in group A , the group treated with hydralazine monotherapy , while propranolol in combination with hydrazaline ( group B ) had some negative effects on fetal development which did not occur in pindolol/hydrazaline combination The obstetric implication s of the use of the beta-adrenoceptor antagonist atenolol have been evaluated in a prospect i ve , r and omized , double-blind , and placebo-controlled study involving 120 women with pregnancy-associated hypertension . The clinical interpretation of antenatal and intrapartum cardiotocographs was uninfluenced by atenolol .  Human placental lactogen concentration fell in the atenolol group , but this was not an indicator of subsequent fetal distress . Other obstetric indices , such as urinary estriol excretion , were the same in both groups . Spontaneous premature labor occurred in five women receiving placebo but in none who received atenolol . Together with previously reported findings on pregnancy outcome , our study leads us to conclude that beta-blockers such as atenolol can appropriately be used in the management of hypertension during pregnancy We compared propranolol with methyldopa in a r and omized prospect i ve study of 28 women with pregnancy associated hypertension . Both drugs were equally effective in controlling maternal hypertension . There was no significant difference in the birthweights of the babies in each group . However one infant born to a mother receiving propranolol had symptomatic hypoglycaemia . The mean peak levels of propranolol , propranolol glucuronide , 4-hydroxypropranolol , and 4-hydroxypropranolol glucuronide were not significantly different in the first , second , third trimesters and at least 3 months post partum . The mean peak plasma level of naphthoxylactic acid however was significantly less in the third trimester compared with post partum levels . Propranolol and its metabolites were found to cross into breast milk with the maximum dose likely to be ingested by the infant as either propranolol or propranolol glucuronide being 7 micrograms of propranolol per 100 g of breast milk , being approximately 0.1 % of the maternal dose A controlled prospect i ve evaluation of pregnancy complicated by chronic hypertension is proposed and preliminary data on population selection and pregnancy outcome are presented . Sixty-three women with evidence of underlying hypertensive disease were followed prospect ively throughout pregnancy . Twenty-three patients were followed in a protocol of intensified prenatal care and r and omized assignment of antihypertensive agents : placebo , hydralazine , or methyldopa .  Forty patients were followed in the high-risk pregnancy clinics at Duke University . The incidence of preeclampsia in the r and omized prophylactic antihypertensive group was statistically lower than that in the nonr and omized group ( 8.7 versus 32.5 % ; P<.01 ) . There were no other statistically significant differences between the groups . The 63 hypertensive women had a high incidence of diabetes mellitus diagnosed during pregnancy ( 49.2 % ) as compared to the authors ' general obstetric population ( 8.1 % ) Atenolol and bisoprolol , two beta-1-selective blockers , were compared in patients with mild and medium severe hypertension . Forty patients with a diastolic blood pressure of 95 - 115 mm Hg were two weeks after discontinuation of treatment divided at r and om into two groups treated with 50 mg atenolol and 5 mg bisoprolol . If the blood pressure was not affected by this dosage , the dose was raised to 100 mg atenolol and 10 mg bisoprolol . The blood pressure readings , heart rate , side effects of the drugs , laboratory and echocardiographic values were followed up for a period of three months . The authors recorded a marked decline of pressure and heart rate after the first week of therapy , the pressure readings in an upright position did not differ statistically from values in a sitting position , orthostatic hypotension was not recorded . The rate of success of bisoprolol was 85 % , of atenolol 75 % . During treatment no serious side-effects were observed . The biochemical parameters and echocardiographic values were not altered significantly by treatment . Atenolol and bisoprolol are two effective beta-1-selective blockers with a comparable effect in the treatment of mild and medium severe hypertension . They are useful in monotherapy as well as in combination with other antihypertensive drugs . In hypertension associated with diabetes mellitus , incipient bronchopulmonary disease and pregnancy they are also indicated . They are well tolerated also by elderly patients , an advantage of bisoprolol may be that it has a smaller impact on pressure and heart rate during the night Our objective was to determine if maternal urinary calcium excretion is altered during treatment of mild preeclampsia remote from term with the calcium channel blocker nifedipine .  One hundred forty-eight women with mild preeclampsia were r and omly allocated to treatment with either bed rest alone ( n=64 ) or in combination with nifedipine ( n=84 ) at 26 - 36 weeks ' gestation . All women had 24 hr urine sample s collected for creatinine clearance and calcium excretion determination prior to therapy and during treatment . There was no difference in gestational age at the time of urine collection between the two groups . There were no differences in 24-hr creatinine clearance and calcium excretion between the groups prior to therapy . When followed longitudinally , there was a significant reduction in calcium excretion within each group ( p=0.0005 control group , p < 0.0001 nifedipine group ) . Further , a significant reduction in calcium excretion was noted following nifedipine therapy ( 62+/-94 mg Ca/24 hr ) compared to the control group ( 143+/-153 mg Ca/24 hr ) , p < 0.001 . Consistent with previous studies , we have shown that progressive hypocalciuria is a feature of preeclampsia . Further , urinary calcium excretion decreased despite nifedipine therapy . Altered urinary calcium excretion may be less reflective of the progression in severity of preeclampsia in patients treated with nifedipine In a double blind study , 20 gravidas with pre-eclampsia were r and omly allocated to treatment with either propranolol 120 mg/day or pindolol 15 mg/day for 7 days . Flow velocimetry was performed before and after treatment to assess the influence of these two regimens of beta blocker on the feto-placental circulation . A continuous wave Doppler unit was used to measure umbilical and uterine artery flow velocity waveforms . The systolic/diastolic ( A/B ) ratio and the systolic minus diastolic divided by systolic (A-B)/A ratio ( resistance index ) were used as indexes of blood flow resistance in the umbilical and uterine arteries , respectively . A resistance to flow in the uteroplacental circulation was significantly less in patients treated with pindolol compared to those treated with propranolol ( P less than 0.01 ) . The same pattern was also found in umbilical velocimetry , although the statistical significance was borderline ( P = 0.06 ) . Although both drugs were equally effective in reducing blood pressure at rest , their effect on the peripheral resistance was different . Pindolol appears to act in part through a peripheral vascular mechanism . Our data support this assumption because the flow in the uteroplacental bed , as reflected by a decrease in resistance index , improved when patients were treated with the drug pindolol OBJECTIVE To assess the effects of nimodipine on retinal blood flow in patients with pregnancy induced hypertension ( PIH ) . METHODS Fourteen patients were studied with color flow Doppler before and after 30 mg nimodipine administered orally , while other fourteen patients received intravenous magnesium sulfate as control group .  Central retinal artery flow velocity waveforms were measured and pulse index ( PI ) were calculated . RESULTS Nimodipine reduced the central retinal artery PI significantly from 0.92 + /- 0.14 to 0.75 + /- 0.22 . It also reduced systolic blood pressure from 20.7 + /- 2.5 kPa to 19.8 + /- 1.5 kPa and diastolic blood pressure from 14.4 + /- 2.3 kPa to 13.6 + /- 1.9 kPa . CONCLUSIONS Nimodipine may dilate central retinal arteries . Changes in pulsatility index in retinal arteries maybe indicative of similar changes in other cerebral vessels . Nimodipine may be another choice of PIH therapy Calcium channel blockers have been used successfully in the treatment of pregnancy hypertension and premature labor . Only limited information related to their effect on uterine blood flow during pregnancy is available . In this study we measured the ratio between peak systolic to end-diastolic flow velocity ( S/D ratio ) in the ascending branch of the uterine artery in nine pregnant patients prior to and following a 10-mg dose of sublingual nifedipine . Another group of seven matched patients who received a placebo served as a control group . All studies were performed between 17 and 22 weeks gestation . The S/D ratio decreased shortly after sublingual nifedipine , but the change was not significant . It increased gradually afterward so that by 60 minutes it returned to the control value . The mean systolic blood pressure decreased by 8.6 % to its lowest value after 25 minutes ( P less than 0.01 ) . The mean diastolic blood pressure decreased by 15.7 % to its lowest value after 35 minutes ( P less than 0.002 ) . Maternal heart rate did not change significantly . No significant changes were observed in any of the measured variables in the placebo group . In conclusion , nifedipine does not induce significant changes in uterine arterial resistance in midtrimester and may be considered during pregnancy , providing that large fluctuations in maternal blood pressure are avoided OBJECTIVE The objective of our study was to test the hypothesis that treatment with nifedipine for mild preeclampsia remote from term reduces the number of days of maternal hospitalization and improves pregnancy outcome . STUDY DESIGN A total of 200 patients at 26 to 36 weeks ' gestation were r and omly allocated to treatment with either bed rest alone ( n = 100 ) or bed rest in combination with nifedipine ( n = 100 ) . RESULTS Patients receiving nifedipine had significantly lower systolic ( p < 0.0001 ) and diastolic ( p < 0.0001 ) blood pressures during therapy . Severe hypertension as an indication for delivery was significantly ( p < 0.05 ) more frequent in the bed-rest-alone group . The two study groups had similar average days of maternal hospitalization ( 12.6 + /- 7.9 vs 12.3 + /- 10.3 ) and pregnancy prolongation ( 22.3 + /- 13.5 vs 22.5 + /- 15.7 ) . There were no differences between groups with respect to birth weight , incidences of small-for-gestational-age infants and preterm birth , number of days spent in special care unit , or cord blood gas measurement . CONCLUSION Nifedipine therapy for preeclampsia reduces maternal blood pressure but does not reduce number of days of maternal hospitalization or improve perinatal outcome In a controlled trial pregnant women who were hypertensive before the 28th week of gestation were r and omly allocated to treatment with methyldopa or no anti‐hypertensive treatment . The children from these pregnancies have been re‐examined at four years of age and their development compared with a r and om sample from the same maternity hospital population . Their health , height , weight , and the incidence of sight , hearing and speech problems did not differ . None had gross neurological abnormalities . Boys in the treated hypertensive group had significantly smaller heads than in the other two groups , but there was no correlation between head circumference and developmental score in this group ( r = 0.020 ) . On average the children in the r and om sample were the most advanced when assessed a global score of development . In each developmental sector the mean score for the treated hypertensive group was consistently higher than the untreated hypertensive group . We conclude that maternal hypertension is associated with slight developmental delay in early childhood . There are some indications that treatment with methyldopa may reduce this effect Two hundred primigravid women with mild preeclampsia at 26 - 35 weeks ' gestation were r and omly allocated to treatment with hospitalization alone or combined with labetalol . There were no differences between the two groups in mean systolic or diastolic pressures , mean gestational age , or initial laboratory findings at time of entry . Patients in the labetalol group demonstrated a statistically significant ( P less than .005 ) decrease in blood pressure during treatment . No such decrease occurred in the hospitalization-alone group . Both groups exhibited significant deterioration in proteinuria , creatinine , and uric acid . The average days of pregnancy prolongation ( mean + /- SD ) were 21.3 + /- 13 and 20.1 + /- 14 days in the hospitalization and labetalol groups , respectively . There were no differences between the groups regarding any of the following : gestational age at delivery , birth weight , number of infants admitted to the special care unit , or cord blood gas measurements . However , the incidence of small-for-gestational-age infants was significantly higher in the labetalol group ( 19 versus 9 % , P less than .05 ) . There were no stillbirths , but one neonatal death in the labetalol group . Treatment of maternal blood pressure in preeclamptic pregnancies with labetalol  did not improve perinatal outcome , and was associated with a higher frequency of fetal growth retardation Abstract . in an open , controlled trial , treatment with a combination of metoprolol and hydralazine was compared with non‐pharmacological management of mild and moderate hypertension in pregnancy . One hundred and sixty‐one women participated in the study . the drug‐treated group showed significantly better blood pressure control than the group not given antihypertensives .  Induction of labor before term , because of maternal or fetal complications , was somewhat more frequent in the control group . Nine women in the treatment group and 5 in the control group developed albuminuria . Three infants in the drug‐treated group died perinatally , and one in the control group . the outcome for the newborns was similar in both groups concerning birth weight , head circumference and Apgar score and in the frequencies of respiratory distress , bradycardia and hypoglycemia . the better blood pressure control achieved with these drugs makes it possible to treat the patient at home and reduce the risk of emergency delivery , but treatment does not seem to be m and atory for a good outcome of the pregnancy in cases of mild and moderate hypertension during pregnancy The therapeutic effect of the calcium antagonist ; Nifedipine was assessed in 30 patients with pre-eclampsia . Cases were r and omly allocated into two groups ; a study group ( n = 20 ) who received Nifedipine capsules ( 20 mg every 8 h for 7 days ) and a control group ( n = 10 ) who received placebo capsules with the same regimen . After Nifedipine administration , there was a significant decrease in blood pressure , serum urea and creatinine and 24 h urinary proteins . No significant difference was found in FHR and S/D ratio of the umbilical artery between study and control groups or between initial values and after Nifedipine administration . Preliminary results indicated that Nifedipine decreased blood pressure and improved kidney functions without affecting the umbilical artery blood flow in cases of pre-eclampsia OBJECTIVE To study the effect of prepared rhubarb in treating patients with pregnancy induced hypertension ( PIH ) and its therapeutic mechanisms . METHODS Prepared rhubarb and nifedipine were given to the study group , while the nifedipine was given to the control group alone . The blood lipid , renal function , blood coagulation , fibrinolysis and immunological parameters were monitored . RESULTS In the study group , ( 1 ) Levels of triglycerides ( TG ) and low density lipoprotein-cholesterol ( LDL-C ) decreased and high density lipoprotein-cholesterol ( HDL-C ) level increased significantly ; ( 2 ) Plasma level of fibronectin ( FN ) and plasminogen activator inhibitor ( PAI ) lowered significantly , plasma antithrombin ( AT-III ) level unchanged ; ( 3 ) Serum beta 2 microglobulin ( beta 2-MG ) level and urinary level of N-acetyl-beta-D-glucosaminidase ( NAG ) and interleukin-6 ( IL-6 ) decreased significantly ; ( 4 ) CD8 of blood increased , CD4/CD8 and circulating immune complex ( CIC ) of blood reduced obviously . All of the above-mentioned parameters in the study group were significantly different from that of the control group . CONCLUSION The prepared rhubarb could reduce the vascular endothelial cell 's damage significantly and alter the immune balance , which is effective in treating the PIH The placenta and the umbilical cord obtained from 18 women with pregnancy‐induced hypertension were investigated by light microscopy . The umbilical artery was studied by electron microscopy . 10 placentae and umbilical cords from normal pregnancies served as controls . The study was performed as a double‐blind r and omized controlled study in which 11 women were allocated to magnesium and 7 to placebo treatment . The treatment comprised a 48‐hour intravenous magnesium/placebo infusion followed by daily oral magnesium/placebo intake until one day after delivery . Magnesium supplement  increased birth weight and placental weight significantly . Light microscopic study of the placentae and the umbilical cord arteries showed no difference between the three groups concerning the occurrence of infa rct ions , cytotrophoblastic hyperplasia , vasculo‐syncytial membranes , basement membrane thickening , stromal fibrosis or intervillous fibrin . Ultrastructurally , the endothelial cells of the umbilical arteries from women with pregnancy‐induced hypertension showed a significant increase in the amount of dilated endoplasmatic reticulum and basal laminae thickness when all 18 cases were compared with the controls . There was no significant difference when the magnesium group , the placebo group and the control group were compared separately . The present study suggests that magnesium supplement has a benefical effect on fetal growth in pregnancy‐induced hypertension . With regard to the light and electron microscopic changes we were unable to demonstrate any significant difference between the magnesium , placebo and control groups A total of 242 women with moderate hypertension in pregnancy completed a controlled trial of methyldopa ( Aldomet ) . The hypotensive effect of methyldopa was similar to its action in non‐pregnant individuals and greatly reduced the frequency of severe hypertension occurring antenatally and in labour . As pregnancy advanced , an increasing daily dose of methyldopa was needed and there was a greater use of additional hypotensive therapy . Seventeen ( 14·5 per cent ) women assigned to methyldopa had to be transferred to another drug or had to stop treatment completely because of minor side effects , of which the commonest were lack of energy and dizziness . No serious side effects were encountered . Nine per cent of the untreated women developed severe hypertension which required treatment later in their pregnancies . Six weeks after delivery , nearly all the patients were able to stop Forty-four consecutive patients referred for treatment because of hypertension ( greater than 150/90 mmHg ) occurring during pregnancy were r and omly allocated to one of two treatment groups , hydralazine alone ( n = 21 ) or hydralazine combined with pindolol ( n = 23 ) . Satisfactory blood pressure control ( diastolic pressure less than 90 mmHg ) was achieved in 86 % of patients receiving hydralazine alone and 91 % of those on combined therapy . Although the treatment did not lower the overall incidence of hypertensive complications it appeared to delay the onset of such complications until successful surgical intervention was possible . Fetal outcome was similar in both groups and there was no perinatal mortality in this high-risk population . Although blood pressure control was similar in both groups of patients , combined therapy with hydralazine and pindolol can be considered to be superior to hydralazine monotherapy , since in patients treated with the combination the incidence and intensity of troublesome side-effects was markedly lower Objective To compare the effect of routine treatment with the calcium channel blocker nifedipine in mild to moderate hypertension in pregnancy Summary . Two treatment strategies were compared in 155 women with pregnancy‐induced hypertension who were also given comprehensive non‐pharmacological care . The mean gestation at entry was 28 weeks . As long as the diastolic blood pressure ( DBP ) remained below 106 mmHg , oxprenolol , or oxprenolol plus dihydralazine , were given to the early treatment group , and matching placebos to the control group . Open antihypertensive treatment was provided for patients whose DBP rose above 105 mmHg . Proteinuria occurred in seven women in each group . In the early treatment group , 13 of the 78 women were delivered by caesarean section ; the corresponding numbers in the control group were 27 of 76 ( 17 vs 36 % , 95 % confidence interval ( CI ) of difference : 5‐33 % ) ; the sections included seven and 16 in the early treatment and control groups , respectively , for severe hypertension and /or fetal distress . There were five perinatal deaths , two in the early treatment group and three in the control group . Early treatment did not influence gestational age at birth or birthweight . Respiratory distress syndrome occurred in four infants in the early treated group and in 10 in the control group ; 14 infants in the former group and 26 in the latter were in hospital for more than 10 days ( 18 vs 35 % ; 95 % CI of difference 4.32 % ) . These results indicate that early antihypertensive treatment with oxprenolol  is safe for the fetus and newborn in pregnancy‐induced hypertension , but has no advantage over non‐pharmacological care in terms of fetal growth . However , it may prevent acute hypertension in late pregnancy and associated fetal distress , and thus reduce the number of caesarean sections This is a prospect i ve r and omised controlled study in 21 women admitted with preeclampsia in the third trimester . The mean arterial blood pressure decreased by 11.1 mmHg ( 95 % confidence interval -14.9 to -7.3 mmHg ) in the methyldopa group , and by 9.3 mmHG ( 95 % confidence interval-14.4 to -4.2 mmHG ) in the isradipine group . The maternal heart rate decreased by 6.9 beats per min ( 95 % confidence interval -11.6 to -2.2 bpm ) during methyldopa treatment , and by 2.5 beats per min ( 95 % confidence interval -9.2 to 4.3 ) during isradipine treatment . Pulsatility index in maternal and fetal vessels was not affected by either of the two drugs . The birth weight and placental weight and neonatal outcome were similar and uneventful . The hypotensive effect was similar for methyldopa and isradipine . Except reduced maternal heart rate on methyldopa , fetal and uteroplacental hemodynamics were not altered during treatment of preeclampsia with methyldopa or isradipine OBJECTIVE To determine the efficacy of Nifedipine on postpartum blood Loss in patients with Pregnancy Induced Hypertension ( PIH ) . METHODS 64 cases of PIH were r and omly divided into study group ( n = 32 ) and control group ( n = 32 ) . Before labor Nifedipine 10 mg-20 mg was given three time daily for all cases . In study group Nifedipine was taken orally every 6 hours during the labor course until the end of second stage . In control group Nifedipine was not given in the labor stages . The postpartum blood loss was collected and measured carefully within 2 hours after delivery . RESULTS The amount of pastpartum hemorrhage was ( 359.1 + /- 136.6 ) ml in study group which was significantly higher than that of control group ( 268.5 + /- 110.7 ) ml P < 0.01 . The postpartum hemorrhage rate in study and control group was 43.75 % and 18.75 % respectively . The difference was statistically significant ( P < 0.05 ) . CONCLUSION During labor using Nifedipine for PIH cases can increase the amount of postpartum blood loss and rate of postpartum hemorrnage We compared the flow velocity waveforms of uterine and umbilical arteries in normotensive and pre-eclamptic patients at mid-gestation . In a r and omised controlled trial we tested the effects of isosorbide dinitrate ( ISDN , nitric oxide donor ) patch therapy on the flow velocity waveform of pre-eclamptic patients at mid-gestation . The resistance indices ( RI ) of human uterine and umbilical arteries were higher in pre-eclamptic patients compared to the normotensive patients . ISDN patch therapy significantly reduced the increased RI values of the umbilical artery in pre-eclamptic patients without any change in systemic blood pressures , but the RI values of the uterine artery were not significantly attenuated . The change of the umbilical artery might be due to the improvement of end-diastolic flow velocity . These results suggest that the feto-placental circulation in pre-eclampsia , perhaps due to the disturbance of the endothelium-dependent vaso-relaxation system , and that ISDN therapy may improve the impaired endothelium dependent nitric oxide system > Objective : To determine the effects of ketanserin given from early in the midtrimester of pregnancy on fetal heart rate parameters later in pregnancy . Methods : Patients with diastolic blood pressure persistently higher than 80 mm Hg between 12 and 20 weeks ' gestational age were r and omized to receive either ketanserin or placebo .  Both groups also got 75 mg of aspirin per day . The fetal heart rate was monitored once every fortnight from 28 weeks ' gestation and weekly from 36 weeks onward . Recordings were made with the Sonicaid System 8000 and continued until the Dawes and Redman criteria were met . Results : The Dawes and Redman criteria were met within 10 min in 54 % of recordings in both study groups , whereas they were not met in 4.5 and 3.3 % of recordings in the ketanserin group and placebo group , respectively ( P = 0.58 ) . The mean time to meet these criteria duration per recording was 16.9 min in the ketanserin group and 16.2 min in the placebo group ( P = 0.83 ) . There were no significant differences between the two study groups in fetal heart rate variability , accelerations , or decelerations before 38 weeks ' gestation . Thereafter the mean minute range and short-term and baseline variability were significantly higher in the ketanserin group , and significantly more accelerations of the fetal heart were recorded in the ketanserin group . Conclusions . Ketanserin does not influence the fetal heart rate adversely and may even be associated with improved recordings late in pregnancy Twentysix women with pregnancy-induced hypertension have been r and omly treated with either labetalol or Aldomet . A more satisfactory control of blood pressure was obtained with labetalol with minimal side-effects . After two weeks of treatment with labetalol  renal function had significantly improved with a markedly lower incidence of proteinuria . More patients went into spontaneous labour following labetalol than following Aldomet ; the Bishop score was also higher in this group . No adverse effects attributable to labetalol were noted in the baby either ante- or post-natally It is the development of proteinuria in pregnancy-induced hypertension which is associated with an increased perinatal mortality . There is some evidence to suggest that labetalol may diminish the amount of proteinuria in patients who have already developed proteinuric pre-eclampsia . A r and omised controlled study design was used to investigate whether labetalol treatment , started when a persistent diastolic blood pressure greater than 90 mmHg was observed , influenced the subsequent development of proteinuria . One hundred and fourteen women with singleton pregnancies and hypertension in the absence of proteinuria were r and omised to receive either labetalol or no antihypertensive therapy .  At recruitment maternal age , blood pressure and gestation  were similar in both the labetalol and control groups . There was no difference in the frequency , quantity or timing of subsequent proteinuria between treatment and control groups . Overall 34 % of primigravidae and 10 % of parous women developed proteinuria .  Labetalol did , however , control the blood pressure in 45 of the 51 treated women ( 88 % ) within 24 h. This effect was often shortlived requiring dose escalation after 3 to 5 days in the majority of cases . Labetalol was well tolerated and no significant maternal toxicity was noted OBJECTIVE To compare nifedipine ( group 1 ) with methyldopa ( group 2 ) in the management of pregnancy induced hypertension ( PIH ) . DESIGN A prospect i ve clinical trial . SETTING Obstetric Unit , General Hospital , Peradeniya . PATIENTS A total of 126 patients with PIH were allocated alternately to either group . The patients in group 1 received nifedipine 30 to 90 mg/day and in group 2 methyldopa 750 to 2000 mg/day . MEASUREMENTS Blood pressure , the extra days added to the pregnancy , number of patients treated for acute hypertensive episodes , maturity of fetus at birth , mode of delivery , birth weight , intrauterine deaths , Apgar score , maternal side effects and complications . RESULTS The two groups on admission to the study had similar periods of gestation ( group 1 , 33.6 + 5.9 , group 2 , 34.1 + 4.2 ) , systolic blood pressure in mmHg ( 151 + 22 , and 154 + 24 ) and diastolic blood pressure ( 108 + 12 , and 108 + 12 ) . The results showed no differences between the two groups , with respect to maturity of fetus at delivery ( 35.1 + 5.5 , and 35.7 + 2.9 ) , mode of delivery , number of intrauterine deaths , average systolic blood pressure in mmHg ( 148 + 14 and 152 + 16 ) , average diastolic blood pressure ( 102 + 8 and 104 + 9 ) , highest systolic blood pressure ( 169 + 24 and 167 + 30 ) , highest diastolic blood pressure ( 115 + 12 and 116 + 11 ) , birth weight in kg ( 2.015 + 0.957 , and 1.922 + 0.660 ) and number of days added to the pregnancy ( 7 + 7 , 9 + 11 ) . The Apgar score for group 2 was better than in group 1 , and less patients in group 2 required treatment for acute hypertension during the period of study . CONCLUSIONS The results of our study indicate that nifedipine is as effective as methyldopa in the treatment of PIH This is an evaluation of the methodology of blood pressure measurement in a high-risk obstetric clinic .  Blood pressure values were obtained from 149 patients by the clinic staff and the research project coordinator . The project coordinator using the r and om-zero sphygmomanometer measured lower systolic and higher diastolic values . The diastolic and systolic values increased after 30 weeks of pregnancy up to term . Agreement among observers is low for diastolic blood pressure . The clinic staff measured about 50 % of the values with a zero terminal digit as compared with only 14 % by the project coordinator . The fourth Korotkoff sound can be recorded in 83 % of the patients . The mean diastolic blood pressures obtained with the fourth sound are significantly higher than when the fifth sound is used . Recommendations are offered for blood pressure measuring during pregnancy , and it is strongly suggested that the same method ologic rigor be used as in any other medical procedure Objective To compare the effects of treatment with nicardipine and metoprolol in patients with hypertension during pregnancy Thirty patients matched for age , parity , socioeconomic status and severity of pregnancy induced hypertension ( PIH ) were r and omly allocated to treatment with metoprolol or methyldopa . The average fall in diastolic blood pressure was significant in the group treated with metoprolol as compared with the methyldopa group ( p less than 0.01 ) . There were 3 perinatal deaths in the methyldopa group and 1 in the metoprolol group ; the mean birth weight of the babies was higher in cases treated with metoprolol . The results suggest metoprolol to be more efficacious with regard to control of hypertension and fetal outcome in cases of pregnancy induced hypertension OBJECTIVES To evaluate the efficacy of methyldopa in the treatment of mild pre-eclampsia , to prevent its progress and to investigate its effect on the pregnancy outcomes . DESIGN S R and omised clinical trial . SETTING Wad Medani Hospital in the central Sudan . SUBJECTS Seventy primigravidae with single , alive baby of 28 - 36 weeks gestational age suffering from true mild pre-eclampsia were enrolled . The patients were r and omised in two groups , treatment group who received methyldopa 750 - 4000 mg/day ( n=34 ) and a control group who received no treatment ( n=36 ) . All the ( treatment and control ) patients were drug followed as in- patients till the delivery , seen with their babies on the days 7 , 42 after the delivery . MAIN OUTCOMES MEASURES The outcomes examined were , rise of the diastolic blood pressure to 110 mm Hg or more , occurrence of imminent eclampsia or the eclampsia , if the maturity could be achieved , occurrence of intrauterine growth retardation , abruptio placentae , mode of delivery , birth weight , placental weight , perinatal death , Apgar score and referral of the babies to the pediatrician . RESULTS Three out of 34 ( 8.8 % ) of the treatment group had a rise in the diastolic blood pressure of 110 mm Hg , 18/36 ( 50 % ) of the control had a rise in the diastolic blood pressure of 110 mmHg ( p < 0.05 ) . Three out of thirty four ( 8.8 % ) of the treatment group developed imminent eclampsia , while 10/36 ( 27.8 ) of the control group developed imminent eclampsia ( p < 0.05 ) . The maturity was achieved in 82.3 % and 88.8 % of the treatment and the control , respectively ( p > 0.05 ) . There were ten ( 14.2 % ) perinatal deaths , four of them in the treatment group , while six in the control ( p > 0.05 ) . There was no difference regarding birth weight , occurrence of intrauterine growth retardation , placental weight , mode of delivery , Apgar score , referral of the babies to the paediatrician . No patient developed eclampsia or abruptio placenta ; there was no maternal death in both groups . CONCLUSION Methyldopa can prevent the progress of the mild pre-eclampsia to severe pre-eclampsia , without affecting the maturity , birthweight or the neonatal outcomes One hundred pregnant women with hypertension ( defined as diastolic blood pressure at or above 95 mm Hg ) were allocated at r and om to treatment with methyldopa or oxprenolol and were compared with nonhypertensive controls matched according to parity and gestation at delivery . The patients were also stratified into those entering the study early ( before 32 weeks ' gestation ) and those entering late ( after 32 weeks ' gestation ) . Although there were no differences in diastolic blood pressure between the hypertensive groups before or during treatment , in the early entry group the systolic blood pressure at entry of those allocated to oxprenolol was significantly higher than that of those receiving methyldopa ; this difference remained throughout the treatment period . Also in the early entry group further increments of drug treatment were required to control blood pressure of patients receiving oxprenolol than in those receiving methyldopa . The eventual fetal outcome for all patients treated with methyldopa was the same as that for those treated with oxprenolol ;  birth weight , placental weight , head circumference , and Apgar score were not significantly different and there were no stillbirths in either group The objective of the present study is to compare the effectiveness of transdermal glyceryl-trinitrate versus oral nifedipine in lowering blood pressure in patients affected by pregnancy-induced hypertension ( PIH ) . Thirty-six consecutive pregnant women have been evaluated at different gestational ages after the diagnosis of PIH or preeclampsia ( PE ) . After a 24-h ambulatory blood pressure monitoring , patients were allocated to three groups : those receiving oral nifedipine and those receiving transdermal glyceryl-trinitrate in a continuous ( 24 h/day ) or intermittent ( 16 h/day ) administration . A second blood pressure monitoring was performed after 2 weeks of treatment . Systolic and diastolic blood pressure were compared by using the Cosinor method looking at mesor , amplitude , and acrophase . Baseline systolic and diastolic blood pressure was similar among the three groups . Neither the transdermal glyceryl-trinitrate administered for 24 or 16 h nor oral nifedipine affected systolic and diastolic blood pressure . Analysis of variance showed that the posttreatment values were similar among the groups . Further studies are needed to verify the possible use of transdermal glyceryl-trinitrate as an antihypertensive drug during pregnancy 1 . This study evaluates the perinatal outcome of infants born to ninety‐five mothers with hypertension in pregnancy whose blood pressure was treated in a double blind trial comparing clonidine hydrochloride ( C ) and α‐methyldopa ( A ) 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 r and omized 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 The  growth and development of three groups of infants were prospect ively assessed from birth to 12 mth . In two groups the mothers had been hypertensive before the 28th wk of gestation ; one group was r and omly allocated to specific hypotensive therapy , the other group was allocated to no specific treatment . The third group was a sample of the hospital population . General health , and the incidence of sight and hearing problems did not differ . Infants in the treated hypertensive group had had more perinatal problems , and there was an excess of infants with relatively small heads for their gestational age at birth . At 6 mth their heads were still smaller than the hospital sample , but by the age of 1 yr the difference was no longer present . The neurological status of infants in the untreated hypertensive group was less favourable in the neonatal period , and there was still an excess of infants in this group rated question able on neurological assessment at the age of 12 mth . In both hypertensive groups there was an excess of infants with delayed fine-motor function at 6 mth , and in the untreated group there was an excess with delayed gross-motor function at 12 mth compared with the hospital sample . Our varied findings draw attention to the dangers of assessing the effects of different pregnancy conditions in terms of neonatal mortality and morbidity alone . Our date indicate that follow-up should extend for longer than 12 mth when the effects of adverse pregnancy factors and their management are under consideration . Further evaluation will be made when these children are 4 yr old A prospect i ve , double-blind , r and omized controlled trial was carried out , comparing α-methyldopa and clonidine hydrochloride in 100 pregnant women with hypertension . There was no difference in hypotensive effect or reported maternal side effects with either agent . There was one neonatal loss in each group ( 98 % survival ) . Neither drug caused clinical ly significant hypotension nor rebound hypertension in the neonates . Clonidine hydrochloride , like methyldopa , appears to be a safe antihypertensive agent in pregnancy Abstract . A review is presented as regards the neonatal effects of beta‐blocking agents in hypertension during pregnancy . Experience points to low fetal and neonatal risks , but firmly based data concerning the neonates are very scanty . An on‐going double‐blind study is presented in which pregnant women with hypertension are r and omly allocated to either metoprolol or placebo treatment . One of the aims is to study the postnatal adaptation of the infants . The following measurements , recordings and examinations are performed : anthropometric measurements , Apgar score , blood gases and acid‐base status in umbilical ( venous and arterial ) blood , lactate and hypoxanthine in umbilical venous blood , catecholamines in umbilical arterial blood , pulse rate , blood glucose and a quantitative neurobehavioral assessment in the neonatal period The antihypertensive efficacy of acute treatment with the serotonin receptor antagonist , ketanserin , in women with preeclampsia has been recently documented . The purpose of this study was to determine the safety and efficacy of chronic ketanserin treatment in a group of 20 hypertensive pregnant women : 10 received daily oral doses of ketanserin ( 20 - 80 mg ) , and 10 were treated with oral alpha-methyldopa ( 500 - 2000 mg ) . This study includes ( a ) patients with a sustained elevation of systolic blood pressure higher than 159 mm Hg and /or diastolic blood pressure higher than 99 mm Hg at bed rest , and ( b ) hypertensive patients with systolic blood pressure higher than 140 mm Hg or diastolic blood pressure higher than 90 mm Hg with superimposed symptoms such as headaches , stomach aches , and neurological disturbances .  A significant and comparable decrease in blood pressure was noted in both groups , in relation with pretreatment levels ; no adverse affects were observed in mother or fetus from the ketanserin and alpha-methyldopa groups BACKGROUND Ketanserin , a selective serotonin-2 receptor antagonist , decreases systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) in non-pregnant patients with hypertension , but not in normotensive subjects . Its effect on longitudinal blood pressure ( BP ) patterns in pregnant women has not been documented . OBJECTIVES To assess how ketanserin , given orally , influences maternal BP during pregnancy . DESIGN A double-blind r and omised controlled trial where patients with DBP > or = 80 mmHg between 12 and 20 weeks ' gestation received either ketanserin or placebo . SETTING Tygerberg Hospital , a tertiary referral unit in the Western Cape . SUBJECTS One hundred and two patients who received their study drug for at least 140 days during pregnancy . Patients requiring additional antihypertensive medication were excluded from the analysis . OUTCOME MEASURES Changes in SBP and DBP in relation to gestational age and days since entering the study . RESULTS The mean DBP over the total period was significantly lower in the ketanserin group ( 77 + /- 8.7 mmHg v. 80.8 + /- 9.1 mmHg ) . The decline in DBP was 9.2 mmHg in the ketanserin group and 5.3 mmHg in the placebo group . These differences were detected from within 7 days of therapy and persisted for most of the pregnancy . The mean SBP did not differ at any stage , although the mean fall in SBP was significantly greater in the ketanserin group ( 8.6 + /- 16.7 v. 4.1 + /- 17.1 mmHg ) . CONCLUSIONS Ketanserin decreased DBP during pregnancy significantly more than placebo Cord blood IgE levels and the development of allergy were studied in 29 children born by mothers who had been treated with the beta-adrenergic receptor blocking agent , metoprolol , during the pregnancy and in 23 children of placebo-treated mothers . In 13 ( 45 % ) of the former and 3 ( 15 % ) of the placebo group elevated cord blood IgE levels , i.e. more than 0.9 kU/l and /or obvious or probable allergy developed ( p = 0.03 ) . The findings support previous experimental observations that beta-blocking agents may enhance IgE antibody formation . It also adds to the number of environmental factors that may increase the risk for atopic disease in children 242 women completed a controlled trial of methyldopa ( ' Aldomet ' ) for moderate hypertension in pregnancy . Active treatment was associated with a significantly improved fetal outcome , due in part to a reduced number of mid-pregnancy abortions . There were 9 pregnancy losses in the control group , which included 4 mid-pregnancy abortions , and 1 fetal loss in the treated group . The birthweight and maturity of viable infants were similar in treated and control groups , and a detailed multivariate analysis confirmed that hypotensive treatment had no effect on fetal growth in utero . The better outcome associated with treatment was not due to the prevention of pre-eclampsia , and may be partly due to a direct or indirect effect of methyldopa on uterine activity . Methyldopa is safe to use for the treatment of hypertension in pregnancy in the context of close medical and obstetric supervision Objective To determine the need for , and efficacy of , treatment with labetalol in women with mild‐to‐moderate pregnancy induced hypertension ( PIH ) We describe the results of a prospect i ve study in which 120 women who developed hypertension in the last trimester of pregnancy were r and omly allocated in double blind manner to atenolol or placebo . The mean duration of treatment was five weeks . The only difference between groups during the neonatal period was in respiratory distress syndrome , mainly related to spontaneous premature labour , which occurred in six placebo group babies but in none from the atenolol group . Fifty five children from each group have been followed to 1 year of age . All in the atenolol group are developing normally but one child from the placebo group is brain damaged . These findings do not suggest any short or medium term paediatric complications after the use of beta blockers in pregnancy The safety of use of the calcium channel blocker nifedipine in pregnancy as it affects child development has not been well evaluated . We report the results , with regard to the safety for children of use of nifedipine in pregnancy , on children followed up at 18 months of age born from women recruited in a study comparing routine treatment with nifedipine compared with no treatment 1 BACKGROUND Pre-eclampsia is associated with extensive endothelial-cell damage and platelet activation , result ing in lower production of vasodilator prostagl and ins and increased release of the vasoconstrictors thromboxane A2 and serotonin . Damage to endothelial-cell serotonin-1 receptors leaves vasoconstriction and platelet aggregation mediated by serotonin-2 receptors unopposed . We investigated the role of ketanserin , a selective serotonin-2-receptor antagonist , in lowering the rate of pre-eclampsia among pregnant women with mild to moderate hypertension . METHODS We recruited 138 pregnant women into a double-blind , r and omised , placebo-controlled trial . They had diastolic blood pressure persistently more than 80 mm Hg before 20 weeks ' gestation . 69 women received ketanserin  and 69 received placebo . Both groups also received aspirin . Patients were initially given two tablets daily , increased to four tablets daily in diastolic blood pressure was more than 90 mm Hg . Primary outcomes were the development of pre-eclampsia and severe hypertension , and perinatal mortality . FINDINGS There were significantly fewer cases of pre-eclampsia ( two vs 13 ; relative risk 0.15 [ 95 % CI 0.04 - 0.66 ] , p = 0.006 ) and severe hypertension ( six vs 17 ; p = 0.02 ) in the ketanserin than in the placebo group . There was also a trend towards less perinatal mortality ( one vs six deaths ) but this was not significant ( p = 0.28 ) . Rates of abruptio placentae and pre-eclampsia before 34 weeks ' gestation were lower in the ketanserin group , and mean birthweight was significantly higher . INTERPRETATION We found an association between the addition of ketanserin to aspirin and a decrease in the number of cases of pre-eclampsia and severe hypertension , as well as improved pregnancy outcome among patients with mild to moderate midtrimester hypertension The effects of magnesium were compared with those of placebo in a r and omized double‐blind controlled study of 58 patients with pregnancy‐induced hypertension , of whom 27 received magnesium  and 31  placebo . Twenty patients in each group were nulliparas . The treatment comprised 48 h of either intravenous magnesium or placebo infusion followed by daily oral magnesium or placebo tablets until one day after delivery . Magnesium supplementation significantly reduced maternal mean arterial blood pressure ( MAP ) . The gestational age at delivery was the same in both groups , whereas the relative fetal birth weight among nulliparas was reduced in the placebo group . Unbalanced analyses of variance suggested an influence of magnesium supplement on birth weight . The infants in the magnesium supplemented group spent fewer days in the neonatal intensive care unit . There were no perinatal deaths . Magnesium appeared to be beneficial in the management of pregnancy‐induced hypertension . The better outcome associated with magnesium supplementation may not have been due to reduction of MAP and further studies are needed to clarify whether magnesium influences birth weight OBJECTIVE To evaluate the short-term effects of intravenously given atenolol and pindolol on utero- and umbilicoplacental vascular impedance , fetal hemodynamics and cardiac function in patients suffering from pregnancy-induced hypertension . STUDY DESIGN A total of 24 women were r and omized to receive atenolol or pindolol infusion . By using pulsed color Doppler techniques , uterine , placental arcuate , umbilical fetal middle cerebral and renal arteries were examined before , at the end and 30 min after the end of infusion . Pulsatility indices ( PI ) were calculated to assess vascular impedance . Fetal myocardial function was evaluated by using pulsed Doppler and M-mode echocardiography . Peak systolic velocities from the ascending aorta and pulmonary trunk , and also inner diameters and fractional shortenings of both ventricles were measured . RESULTS Both drugs significantly decreased maternal blood pressure . Immediately after the infusion , maternal heart rate was significantly decreased in both groups ; but the decrease was clearer and lasted longer in the atenolol group . Pindolol caused no changes in utero- or umbilicoplacental vascular impedance , while atenolol increased it in the nonplacental uterine artery . After atenolol infusion , PI in the umbilical artery was higher than after pindolol . Pindolol had no effects on fetal hemodynamics , while atenolol decreased PI value in the fetal renal artery . Peak systolic velocity in the pulmonary trunk was decreased after atenolol . Pindolol did not affect the fetal cardiac function . In subgroups with originally increased utero- or umbilicoplacental vascular impedance , the responses in uterine and umbilical vascular impedance and in fetal hemodynamics and cardiac function after atenolol and pindolol were different compared to whole groups . CONCLUSION Differently acting antihypertensive agents seem to affect differently uteroplacental vascular impedance .  Atenolol may have some direct effects on fetal hemodynamics and cardiac function . According to our results , pindolol seems to be more preferable in the treatment of pregnancy-induced hypertension than atenolol In a r and om controlled trial of methyldopa for the treatment of hypertension in pregnancy presenting before 28 weeks gestation , the newborn in the treated group had relatively smaller head circumferences . This difference persisted at two months of age when correction had been made for birth weight , gestation and sex , but was no longer detectable at six or twelve months . Within the treated group no relationship was found between neonatal head circumference and the total amount or duration of methyldopa received during pregnancy . Comparison of treated and untreated groups according to the time of entry to the study showed that significant differences in neonatal head circumference were only present in patients who entered between 16 and 20 weeks gestation . It is possible that this could be a sensitive period for the interaction of fetal head growth and the onset of specific treatment in hypertensive pregnancy OBJECTIVE AND DESIGN The aim of this study was to evaluate treatment of mild to moderate hypertension ( less than 170/110 mmHg ) in pregnancy in a prospect i ve , r and omised , double-blind trial . SETTING AND PATIENTS Pregnancy outcome was studied for 52 primigravid women , managed in hospital from early in the third trimester . INTERVENTIONS Patients were r and omly allocated either to placebo or to active treatment ( clonidine plus hydralazine ) . MAIN OUTCOME MEASURES AND RESULTS Maternal deterioration dictated withdrawal from trial therapy for eight patients receiving placebo , but for only one receiving active treatment . Maternal proteinuria occurred only in the placebo group . Intention-to-treat analysis showed a significant increase in premature delivery for complications in the placebo group ( P less than 0.05 ) , despite active blood pressure treatment for those withdrawn from the group because of severe hypertension ( 170/110 mmHg or higher ) . Neonatal respiratory distress requiring intensive care occurred only in babies born to women in the placebo group . There were no perinatal deaths and no adverse effects of treatment in the neonates . CONCLUSIONS The study indicates that early control of mild hypertension in pregnancy can prevent progression to emergency premature delivery Thirty-two consecutive women with pregnancy-induced hypertension of early onset were r and omly allocated to treatment with pindolol or methyldopa . There was no difference between the groups in regard to the average time of delivery ( 36.33 vs. 36.6 weeks ) and weight of the newborn ( 2850 vs. 2870 g ) . A significant drop in systolic ( P less than 0.005 ) and diastolic ( P less than 0.05 ) blood pressure was observed in the group of patients treated with pindolol as compared with the methyldopa group . In the pindolol group an improvement in renal function was observed as determined by CCT and serum creatinine . There were no side effects from the drugs in the mother or in the newborn Abstract A controlled trial of bendrofluazide and methyldopa in 100 patients with hypertension in pregnancy is reported . In patients developing hypertension before twenty weeks of pregnancy treatment seemed to improve the chances of a successful outcome to the pregnancy . In those developing late hypertension treatment was of no value in the presence of proteinuria . The presence or absence of proteinuria seemed to be of more importance than the level of the diastolic pressure Fifty-three pregnant women with moderately severe hypertension were r and omly allocated to treatment with methyldopa or oxprenolol . There were no significant differences between the groups in age , height , weight , parity , or stage of gestation at the start of treatment . The outcome of pregnancy was better in the group treated with oxprenolol , with greater maternal plasma volume expansion and placental and fetal growth . No intrauterine deaths occurred in either group , and antepartum fetal distress , detected by oxytocin challenge testing , was evident in only one patient , who received methyldopa . This infant , and one other in the methyldopa group , died in the neonatal period . No neonatal deaths occurred in the oxprenolol-treated group . Even in this small number of patients these results were considerably better than those in untreated women with hypertension of similar severity . Apgar scores in both groups were equivalent at birth , while blood sugar concentrations were higher in the oxprenolol group . Oxprenolol appears to be safe and effective in controlling hypertension during pregnancy . There was no evidence of harmful effects on the fetus , and oxprenolol may offer a selective advantage over methyldopa for fetal growth and wellbeing in utero
target: REVIEW ER 'S CONCLUSIONS It remains unclear whether antihypertensive drug therapy for mild-moderate hypertension during pregnancy is worthwhile
background: BACKGROUND Mild-moderate hypertension during pregnancy is common .
  Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease , and thereby improve outcome .
  OBJECTIVES To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy .