title: Intravenous labetalol and intravenous dihydralazine in severe hypertension in pregnancy. Intravenous Labetalol and Intravenous Diazoxide in Severe Hypertension Complicating Pregnancy Sublingual nifedipine compared with intravenous hydrallazine in the acute treatment of severe hypertension in pregnancy: potential for use in rural practice. Oral nifedipine therapy in the management of severe preeclampsia. Efficacy of AT in pre-eclampsia: a case-control prospective trial. Long-term treatment with nicardipine for severe pre-eclampsia. Low-dose diazoxide in the emergency management of severe hypertension in pregnancy. A new treatment of severe pre-eclampsia by long-term epidural anaesthesia Management of hypertensive emergencies of pregnancy by hydralazine bolus injection vs continuous drip--a comparative study. Treatment of hypertension in patients with pre-eclampsia: a prospective parallel-group study comparing dihydralazine with urapidil. Hyperuricaemia and preeclampsia: is there a pathogenic link? Antithrombin therapy for severe preeclampsia: results of a double-blind, randomized, placebo-controlled trial. BI51.017 Study Group. Nifedipine in acute hypertensive emergencies in pregnancy. Maternal and fetal haemodynamics in hypertensive pregnancies during maternal treatment with intravenous hydralazine or labetalol Nifedipine or prazosin as a second agent to control early severe hypertension in pregnancy: a randomised controlled trial Comparison of outcome of labetalol or hydralazine therapy during hypertension in pregnancy in very low birth weight infants Malignant ventricular arrhythmias in eclampsia: a comparison of labetalol with dihydralazine. A randomized, double-blind trial of oral nifedipine and intravenous labetalol in hypertensive emergencies of pregnancy. Dihydralazine or ketanserin for severe hypertension in pregnancy? Preliminary results. Comparison of labetalol and dihydralazine in hypertensive emergencies of pregnancy. Ketanserin versus dihydralazine in the management of severe early-onset preeclampsia: maternal outcome. A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy. Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia. Short-term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol An open trial comparing isradipine with hydralazine and methyl dopa in the treatment of patients with severe pre-eclampsia. Sublingual Isosorbide Dinitrate in the Acute Control of Hypertension in Patients with Severe Preeclampsia Ketanserin and hydralazine in hypertension in pregnancy--a randomised double-blind trial. The optimal dosage of ketanserin for patients with severe hypertension in pregnancy. [The effect of Nifedipine on postpartum blood loss in patients with pregnancy induced hypertension]. Antihypertensive Drug Effects on Placental Flow Velocity Waveforms in Pregnant Women with Severe Hypertension Treatment of severe preeclampsia with antithrombin concentrate: results of a prospective feasibility study. Efficacy and safety of nifedipine tablets for the acute treatment of severe hypertension in pregnancy. Nifedipine or hydralazine as a first‐line agent to control hypertension in severe preeclampsia The haemodynamic effects of ketanserin versus dihydralazine in severe early‐onset hypertension in pregnancy Nifedipine in the Treatment of Severe Preeclampsia Improving placental blood flow in pre‐eclampsia with prostaglandin A1 A randomized, double-blind, hemodynamic evaluation of nifedipine and labetalol in preeclamptic hypertensive emergencies. Treatment of acute pregnancy-related hypertension: labetalol and hydralazine compared.
abstract: The effect of intravenous infusion of labetalol and of dihydralazine in increasing doses was compared in 12 women with severe hypertension in pregnancy . In 5 our of 6 women  labetalol produced a smooth , progressive fall in blood pressure to normal levels with minimal side effects . In 2 our of 6 women on dihydralazine the blood pressure control was satisfactory but in the remaining 4 patients treatment had to by discontinued because of unpredictable , sudden falls in blood pressure . One of the 6 infants of mothers treated with labetalol manifested signs of adrenergic blockade . Continuous infusion of labetalol appears to offer significant advantages in the management of severe  hypertension  in pregnancy and merits further trial Summary : The results of a prospect i ve trial to evaluate the use of diazoxide and labetalol given intravenously in the management of  severe hypertensive disease in pregnancy are presented OBJECTIVES The purpose s of this study were to compare the efficacy of sublingual nifedipine with intravenous hydrallazine in the control of acute hypertension of pregnancy and to make a preliminary assessment whether sublingual nifedipine could be recommended for use by midwives faced with severe hypertension in pregnancy in a rural setting . METHODS Subjects were 200 consecutive patients admitted to Kuala Tereng-ganu General Hospital , Malaysia with severe hypertension in pregnancy between August 1989 and June 1990 . Admission criteria were an ongoing viable pregnancy more than 28 weeks and diastolic blood pressure ( DBP ) more than 120 mmHg . The patients were r and omly divided into 2 groups . In group I , sublingual nifedipine 5 mg was administered and repeated after 15 minutes if DBP > 120 mmHg ; and in group II hydrallazine 5 mg was intravenously injected and repeated after 15 minutes if DBP > 120 mmHg . Both groups were put on hydrallazine infusion if DBP > 120 mmHg after 30 minutes . The Chi-square test was used for analysis with significance at p < 0.05 . RESULTS There was no statistical difference in the efficacy of therapy for decreasing blood pressure between the 2 groups . The groups were comparable by age , parity , gestational age at presentation , birth weight of infants , incidence of postpartum haemorrhage and fetal distress . Caesarian section rates were similar . In the observational studies on nurses administering the drugs , no significant difficulties were observed . CONCLUSION Sublingual nifedipine was comparable to IV hydrallazine in the treatment of acute hypertension of pregnancy . Nurses were able to administer lingual nifedipine without difficulty OBJECTIVE The purpose of this study was to compare the efficacy of nifedipine ( Cordipin ) and hydralazine in lowering blood pressure in severe preeclampsia . METHOD A r and omized , prospect i ve study of 104 patients with severe preeclampsia in the Department of Obstetrics and Gynecology , Korle-Bu Teaching Hospital , Accra , Ghana , was conducted between January 1992 and June 1994 . RESULTS Of the 104 patients recruited into the study , six did not deliver at our hospital and were thus excluded from the study .  Nifedipine and hydralazine as first-line drugs controlled the blood pressure in 44 and 35 patients , respectively , but failed in 5 and 14 , respectively . This was statistically significant ( P < 0.05 ) . The mean birth weight was higher in the nifedipine group ( 2500+/-800 g vs. 2400+/-800 g ) . There were 11 admissions to the neonatal intensive care unit in the nifedipine group and 13 in the hydralazine group but the difference was not statistically significant . CONCLUSION Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion . While hydralazine is administered intravenously and needs strict monitoring , nifedipine is more effective , is easy to administer orally , less dem and ing on hospital staff , convenient and more predictable Pre-eclampsia is an extremely severe condition . It is associated with vasospasm , activation of the coagulation system and abnormal haemostasis . In pre-eclamptic patients increased plasmatic concentrations of fibronectin , laminin , von Willebr and factor ( VWF ) and endothelin are observed . Experimental studies on rats have also shown that the doses of antithrombin III ( AT ) needed to mediate anti-inflammatory processes are much higher than those required to obtain the anti-coagulant effect . The study aim ed to evaluate the clinical efficacy of treatment with high AT doses ( HD ) in comparison with st and ard doses ( SD ) . The primary endpoint was the prolongation of pregnancy defined as time ( in days ) from enrollment to delivery and to assess the maternal bleeding at and after delivery . The secondary endpoint was to demonstrate a role for AT in controlling haemostasis at conventional doses , and the inflammatory state at higher doses . The biochemical parameters assessed were : AT activity ( % ) , Fibronectin ( Fn ) , Fibrinogen , D-dimer , Uricemia , Proteinuria 24h , Protein C Reactive ( PCR ) , Granulocyte Elastase and Endothelin . This study included 23 pre-eclamptic women . Patients were r and omly subdivided into two groups : 10 patients ( " cases " ) were treated with high doses of AT ( 6 vials : 3000 units ) once daily for 5 days , or until delivery , while 13 women ( " controls " ) were treated with doses of AT sufficient to maintain at least 80 % of the activity . High-dose therapy was associated with prolongation of pregnancy by 2.5 days more when compared with controls ( p = 0.03 ; Mann-Whitney test ) . The incidence of clinical significant bleeding was lower in cases than in controls ( mean 550 mL vs. 650 mL , respectively ) . Preventive- and conservative-type treatment of moderate-severe pre-eclampsia , based on the administration high doses of AT , allows a significant prolongation of pregnancy , and thus a better neonatal outcome , as well as less maternal intra- and post-operative bleeding . Fn , PCR and elastase levels ( markers of inflammation ) decrease in the HD group in comparison with SD group . In the HD group , the AT plasma levels were obviously higher both at the end of the treatment ( p < 0.0001 ) and after delivery ( p = 0.03 ) , in comparison with SD group . The fibrinogen and D-dimer levels were above the reference interval in both groups . TPA and PAI 1 were found to be significantly raised in the course of pre-eclampsia . In conclusion , the bio-chemical findings support a role for AT in controlling the haemostasis at conventional doses , and the inflammatory state at higher doses OBJECTIVE To evaluate the safety of long-term nicardipine treatment in severely pre-eclamptic women and their fetuses/newborns . METHODS We divided 50 pregnant women into three groups according to the length of their treatment : short-term treatment of severely pre-eclamptic women ( 7 days or less , n=20 ) ; medium-term treatment also of severely pre-eclamptic women ( 8 - 28 days , n=20 ) ; and long-term treatment of women with severe superimposed pre-eclampsia ( 29 days or more , n=10 ) . RESULTS Nicardipine significantly lowered both systolic ( P<0.01 ) and diastolic blood pressures ( P<0.025 ) in all three groups . The incidence of delivery before 28 weeks of gestation was very low in all three groups . There were no maternal or fetal/neonatal adverse effects . CONCLUSION Our results suggest that long-term treatment with nicardipine for severe pre-eclampsia is as effective and safe as a short- and medium-term treatment The administration of diazoxide to patients with severe hypertension in pregnancy in 60 and 150 mg doses , which are smaller than the usual 300 mg dose , is described . A 60 mg dose is effective and does not cause the undesirable hypotension occasionally produced by larger doses We hypothesised that long term epidural anaesthesia suppresses sympathetic overactivity in pre-eclampsia . Two equal groups of severe pre-eclamptic patients were treated either with long-term epidural anaesthesia ( epidural group ) or bed rest , diet control , and an antihypertensive drug ( control group ) . After 7 days of epidural block , mean arterial blood pressures decreased , platelet count and serum total protein increased in all cases while proteinuria decreased in four cases . All patients treated with a long-term epidural therapy continued their pregnancies for more than 3 weeks after admission . The infants in the epidural group had 1-min Apgar scores above 8 , a body weight of 2240 ± 310 g ( mean ± s.d . ) and normal neonatal progress . In contrast , the pregnancies of eight patients in the control group were terminated within 2 weeks of admission due to severe pre-eclampsia or foetal distress , the birth weight of the infants was 1590 ± 380 g ( mean ± s.d . ) and four had neonatal distress . Progressive worsening in the mean arterial pressure , proteinuria , platelet count and serum total protein was found in these patients . Long-term epidural anaesthesia suppresses the sympathetic hyperactivity and thus improves pre-eclamptic condition  which may open a new treatment in case of progressive severe pre-eclampsia This prospect i ve study was conducted at Dhaka Medical College and Hospital , Bangladesh . The objective was to identify the time required to control high blood pressure levels in obstetric patients by injection of hydralazine in a bolus intravenous dose vs continuous drip .  Seventy-seven patients with eclampsia and hypertensive emergencies comprised the target population . Patients were managed either by hydralazine drip in normal saline ( existing official protocol , n = 33 ) or hydralazine bolus injection ( as experiment , n = 44 ) until diastolic blood pressure fell to 90 - 95 mmHg . Results were compared . Student 's t-test was done for statistical significance , and a P value of < .05 was considered as significant . The groups were similar with respect to maternal age and their mean systolic and diastolic blood pressure  at the time of enrollment . Patients who received bolus injection required less time to achieve the therapeutic goal ( 65.23 + /- 23.38 minutes ) than continuous drip ( 186.36 + /- 79.77 minutes ; P < .001 ) . The experimental group also required significantly lower doses ( 6.68 + /- 1.66 mg ) in comparison to that required by control group ( 20.07 + /- 11.38 mg ; P < .001 ) . There was no overshoot hypotension in either group . The data suggest that hydralazine bolus dose is equally safe and more effective than continuous drip in the management of hypertensive emergencies in pregnancy BACKGROUND The primary objective of treatment in women with severe hypertension and pre-eclampsia is to prevent complications such as encephalopathy and haemorrhage . In many countries dihydralazine is considered the drug of choice for treating hypertension in pregnancy , because it now has been used safely for about 30 years , and the introduction of a new drug in pregnancy is a difficult task with partially unknown hazards . In some other countries combined alpha- and beta-blockers are also used . Taking into account that some patients with pre-eclampsia do not respond to dihydralazine and the drug has serious side-effects like headache and reflex tachycardia , there is some need for developing alternative treatment strategies using drugs that are more adequate for pregnancy than dihydralazine . METHODS Urapidil is a post-synaptic alpha 1 adrenoceptor antagonist , which is widely used to control hypertensive crises unrelated to pregnancy . Since it is known that pre-eclampsia is associated with increased sympathetic activity , administration of an alpha 1 adrenoceptor antagonist provides a reasonable therapeutic basis . So far there is only one report describing the i.v . use of urapidil in the treatment of hypertension in pregnancy unresponsive to dihydralazine and one report which describes the oral use of urapidil . In an earlier pilot study we examined the dose range for i.v . application of urapidil necessary for adequate blood pressure control in patients with pre-eclampsia . In the present r and omized controlled study 26 white women with pre-eclampsia and hypertension in pregnancy were included . Treatment was not blinded . During the initial period of intensive intravenous treatment all subjects were under constant surveillance by a physician and a nurse . RESULTS Effective prolonged control of blood pressure ( values below 150/100 mmHg ) was achieved in all patients of the two groups . In one patient of the dihydralazine group signs of lightheadedness and near syncope were noted . After this side-effect of dihydralazine the patient was treated with urapidil . At the end of the observation period the maternal heart rate in the dihydralazine group was higher than in the urapidil group . CONCLUSIONS Since urapidil decreased the high blood pressure in patients with pre-eclampsia without serious side-effects urapidil appears preferable superior to dihydralazine . The haemodynamic effects of urapidil were more predictable than those of dihydralazine . The reduction of intracerebral pressure could be an additional advantage of urapidil in the treatment of patients with pre-eclampsia OBJECTIVE A hypothesis , based on animal studies and human observational studies , was developed proposing a direct pathogenic link between hyperuricemia and preeclampsia . Epidemiological characteristics of preeclampsia such as its uniqueness to humans and an increased incidence of preeclampsia in multiple pregnancies , increased body mass index , renal and hypertensive disease all have uric acid as their common denominator . Animal studies have linked hyperuricaemia to hypertensive , cardiovascular and renal disease . The aim of the study was to determine whether lowering the serum uric acid levels in preeclampsia would affect biochemical parameters and hypertensive control . DESIGN A r and omized , double-blind , placebo controlled study . SETTING A tertiary referral center . POPULATION Forty women with preeclampsia between 26 and 32 weeks gestation . INTERVENTION Probenecid 250 mg twice daily for seven days . MAIN OUTCOME MEASURES Renal function and haematological parameters , hypertensive control . RESULTS In the Probenecid group , there was a significant drop in the serum uric acid levels . Lower uric acid levels in the Probenecid group had no significant effect on blood pressure . Patients in the Probenecid group had a significantly lower serum creatinine value at the end of the study when compared to patients in the placebo group . Other renal function parameters ( creatinine clearance , urea , 24 h urinary protein excretion ) did not show any significant difference between the two groups . Platelet count differed between the two groups with the platelet count being significantly higher in the Probenecid group at the end of the study . CONCLUSION The significant improvement in the platelet count in the Probenecid group warrants further study A double-blind , r and omized , placebo-controlled trial was conducted to evaluate whether treatment with Antithrombin ( AT ) concentrates improved the clinical and perinatal outcome in patients with severe preeclampsia . Severe preeclamptic patients ( 24 to 35 weeks of gestation . Gestosis Index ( GI ) > or = 6 points ) were r and omized into two groups : 66 received AT and 67 received placebo . There were no statistical differences in the clinical profiles of the two groups . Study drugs were given intravenously once daily for 7 consecutive days . Maternal symptoms were evaluated from the difference of GI between before and after treatment , and fetal findings were evaluated from the changes of the biophysical profile score and the estimated fetal weight gain . Improvement was significantly greater in the AT group for both the GI ( p = 0.020 ) and the estimated fetal weight gain ( p = 0.029 ) . The improvement of coagulation parameters was also evaluated . The D-dimer levels increased significantly in the placebo group ( p = 0.026 ) , but did not change in the AT group . Gestation was significantly prolonged ( p = 0.007 ) , and the number of low-birth weight infants was significantly smaller ( p = 0.011 ) in the AT group . No adverse events related to AT were observed . It is revealed that AT concentrate therapy for preeclampsia is effective and safe , leading to an improved perinatal outcome The effect of nifedipine ( Adalat ; Bayer-Miles)--a calcium channel blocker , which has a well-established place in nonobstetric hypertension -- was compared with dihydralazine in 33 primigravidas with severe hypertension of pregnancy . Patients with a diastolic blood pressure greater than 110 mmHg before drug administration were r and omly assigned to treatment with either nifedipine or dihydralazine . Both drugs were found to be equally efficacious .  Nifedipine , however , showed an earlier onset of action in lowering systolic blood pressure and had the advantage of oral administration 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 Objective To determine whether nifedipine or prazosin is the more appropriate second‐line antihypertensive agent in pregnancy 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 OBJECTIVE Our aim was to assess the impact of beta-adrenergic blockade during the peripartum period on the previously observed high incidence of ventricular arrhythmias in eclamptic parturients . STUDY DESIGN An open , r and omized comparison of intravenous labetalol versus dihydralazine was conducted in 40 eclamptic subjects in the peripartum period .  Cardiac rhythm was assessed by blinded analysis of a 24-hour Holter record by means of the Lown classification of arrhythmias . RESULTS There was a significantly higher incidence of serious ventricular arrhythmias in patients receiving dihydralazine ( 81 % ) than in those receiving labetalol ( 17 % , p < 0.0001 ) . Patients receiving labetalol showed a significant decrease in mean heart rate ( p < 0.0001 ) , whereas patients receiving dihydralazine showed a significant increase ( p < 0.0001 ) . CONCLUSION The introduction of beta-adrenergic blockade into peripartum hypertensive management of eclampsia significantly reduced the incidence of dangerous ventricular arrhythmias . Myocardial oxygen supply/dem and ratio may be improved by beta-blockade OBJECTIVE We sought to compare the efficacies of oral nifedipine and intravenous labetalol in the acute management of hypertensive emergencies of pregnancy . STUDY DESIGN We performed a r and omized double-blind trial of  oral nifedipine ( 10 mg ) and intravenous labetalol ( 20 mg ) in 50 peripartum patients with sustained systolic blood pressure of > /=170 mm Hg or diastolic blood pressure of > /=105 mm Hg . Both agents were repeated at sequentially escalating dosages every 20 minutes until a therapeutic goal of systolic blood pressure of < 160 mm Hg and diastolic blood pressure of < 100 mm Hg was achieved . Crossover occurred if the treatment goal was not achieved after 5 doses . Primary outcome was time to achievement of the therapeutic goal . Secondary outcome variables were agent failure , urinary output , and adverse effects . Data were analyzed by unpaired t test , Mann-Whitney U test , and analysis of variance for repeated measures . RESULTS The time to achieve the blood pressure goal was significantly shorter with nifedipine ( mean + /- SD , 25 + /- 13.6 minutes ) than with labetalol ( 43.6 + /- 25.4 minutes ; P = .002 ) . No patients required crossover therapy . Urine output was significantly increased ( P < .001 ) at 1 hour after nifedipine dosing ( 99 + /- 99 mL ) compared with labetalol ( 44.8 + /- 19.1 mL ) and remained significantly increased at 2 , 6 , 12 , 18 , and 24 hours after initial administration . Adverse effects were infrequent . There were no differences in maternal age , gestational age , number of antepartum patients , or enrollment blood pressures between groups . CONCLUSIONS Both oral nifedipine and intravenous labetalol are effective in the management of acute hypertensive emergencies of pregnancy ; however , nifedipine controls hypertension more rapidly and is associated with a significant increase in urinary output OBJECTIVE To compare the efficacy and safety of intravenous dihydralazine with ketanserin in the management of  severe hypertension in the third trimester . STUDY DESIGN A double blind r and omised controlled trial , comparing 5 mg dihydralazine with 10 mg ketanserin after an intravenous infusion of 500 ml of a crystalloid solution . Medication was repeated every 20 min till the therapeutic goal of 90 mm Hg was reached , to a maximum of 4 dosages . Main outcome measures were treatment failures and emergency deliveries for fetal distress . RESULTS The therapeutic goal was met more often in patients receiving  dihydralazine  ( 36/38 compared to 27/42 ; P < 0.01 ) . The need for delivery for fetal distress did not differ ( 3 after dihydralazine , 1 after ketanserin , P = 0.29 ) No therapy related perinatal loss occurred , but one mother with an undiagnosed phaechromocytoma died 24 h after receiving dihydralazine . CONCLUSION Ketanserin in this dosage is less effective to lower diastolic blood pressure . The place of a fluid load prior to dihydralazine needs to be further investigated , as fetal heart rate decelerations were less common than previously reported Labetalol ( Tr and ate ; Allen & Hanburys ) , a combined alpha- and beta-adrenergic blocking agent , was compared with the more commonly used peripheral vasodilator , dihydrallazine ( Nepresol ; Ciba ) , each administered as an infusion , in the treatment of severe hypertension in 20 primigravidas at greater than or equal to 32 weeks ' gestation . With the dosage regimen used in this study there was a tendency towards more effective blood pressure control with dihydrallazine . The pulse rate was unaffected by labetalol therapy and there were no harmful effects on the neonate or fetus directly attributable to either drug OBJECTIVE An open , r and omized , prospect i ve , multicenter trial was conducted to compare the efficacy and safety of intravenous ketanserin , a selective serotonin 2 receptor blocker , with that of intravenous dihydralazine in the management of severe early-onset ( < 32 weeks ' gestation ) preeclampsia . End points of this study were blood pressure control and maternal outcome . STUDY DESIGN Patients with a diastolic blood pressure > 110 mm Hg were r and omly assigned to receive either ketanserin ( n = 22 ) or dihydralazine ( n = 22 ) as initial therapy . Plasma volume expansion preceded antihypertensive treatment , which was administered according to a fixed schedule . RESULTS The reductions in blood pressure with the 2 drugs were similar ; however , adequate blood pressure control was reached significantly earlier with ketanserin ( 84 + / _ 63 vs 171 + /- 142 minutes , P = .017 ) . Occurrence of maternal complications was significantly lower among patients who received ketanserin  than among patients who received dihydralazine  ( n = 6 vs n = 18 , P = .0007 ) . A significant difference in favor of ketanserin was noted in daily fluid balance . CONCLUSION Antihypertensive efficacies of ketanserin and dihydralazine were comparable , but significantly fewer maternal complications were noted among the patients receiving ketanserin . Ketanserin is an attractive alternative in the management of severe early-onset preeclampsia Sixty peripartum patients with diastolic blood pressures ( BP ) 110 mmHg or higher were r and omized in a 2:1 ratio to receive repeated intravenous injections of either labetalol ( 20 - 80 mg ) or hydralazine ( 5 mg ) until the diastolic BP was below 100 mmHg . There were four treatment failures in the labetalol group ( N = 40 ) and none in the hydralazine group ( N = 20 ) . Hydralazine lowered mean arterial pressure ( MAP ) more than did labetalol ( 33.3 + /- 13.2 versus 25.5 + /- 11.2 mmHg ; mean + /- SD ) , but labetalol had a more rapid effect . There was considerable interpatient variability in the dose of labetalol required to control BP , which could not be predicted by any clinical characteristic before therapy . The duration of action also varied in the labetalol group , with the shortest duration occurring in those patients who required the highest dosage for BP control . No significant fetal or neonatal problems ascribable to drug treatment were noted in the 13 instances in which labetalol was given before delivery . However , fetal distress occurred in two of the six cases involving antenatal hydralazine . We conclude that labetalol appears to be a safe and effective alternative to hydralazine for treating hypertension in the peripartum period , but serious rare side effects have not yet been quantified OBJECTIVE Data are accumulating to suggest that cerebral perfusion pressure may be either abnormally high or low in preeclampsia and eclampsia . Little is known of the cerebral perfusion pressure effects of magnesium sulfate or nimodipine . Our objective in this study was to compare the change in cerebral perfusion pressure in patients with severe preeclampsia r and omly selected to receive nimodipine or magnesium sulfate .  STUDY DESIGN Patients with severe preeclampsia were r and omly selected to receive magnesium sulfate ( 6 g bolus and 2 g/hr intravenous infusion ) or nimodipine ( 60 mg taken orally every 4 hours ) . Transcranial Doppler ultrasonography was used to measure flow velocities in the right and left middle cerebral arteries , and the results were averaged . Measurements were obtained before treatment ( baseline ) and 30 minutes after the magnesium sulfate bolus was completely infused or 30 minutes after the nimodipine was ingested . Studies were performed before any other intervention . The person performing the ultrasonography was unaware of the patient 's group assignment . Estimated cerebral perfusion pressure was calculated with the following formula : Estimated cerebral perfusion pressure = Velocity(mean ) x [ ( Blood pressure(mean ) - Blood pressure(diastolic ) ) /(Velocity(mean ) - Velocity(diastolic ) ) ] . The difference between estimated cerebral perfusion pressure at baseline and after treatment was compared between the 2 groups by means of the Mann-Whitney rank sum test . RESULTS Nine patients were r and omly selected to receive nimodipine and 12 to receive magnesium sulfate . Patient demographics and severity of condition were not significantly different between the 2 groups . The change in estimated cerebral perfusion pressure was significantly different between the groups . Estimated cerebral perfusion pressure increased after nimodipine use and decreased after magnesium sulfate use . CONCLUSION Shortly after administration to patients with severe preeclampsia , nimodipine result ed in increased cerebral perfusion pressure in comparison with magnesium sulfate Abstract Objectives . To assess the efficacy and safety of nicardipine in comparison to labetalol in the initial management of severe hypertension in pregnancy . Design . R and omized prospect i ve study . Setting . The obstetric ward of the teaching hospital of Monastir Tunisia . Patients . Sixty consecutive pregnant women admitted beyond the 24th week of pregnancy with severe hypertension . Intervention . Patients were r and omly assigned to receive intravenously for 1 h either labetalol ( n=30 ) or nicardipine ( n=30 ) . Treatment was titrated to achieve a 20 % lowering of blood pressure ( BP ) . Measurements . Maternal BP and heart rate were measured at inclusion and repeatedly during the first hour following the drugs administration . Fetal heart rate was recorded throughout the study period . The main outcome endpoints were the success rate and the length of time needed to achieve the therapeutic goal . The rate of maternal and fetal adverse events and dose adjustments were also analyzed . Results . Labetalol and nicardipine achieved the 20 % lowering in BP in the same proportion ( 63 % and 70 % success rates , respectively ) . Overall nicardipine caused a significantly greater decrease in systolic and diastolic BP . No patient had any episode of hypotension . The length of time to achieve the BP goal was also similar ( 12 vs. 11 min , respectively ) . Both drugs were well tolerated except for a moderate tachycardia observed with the use of nicardipine . Conclusion . Nicardipine and labetalol are effective and safe in the initial treatment of severe hypertension of pregnancy Placental blood flow is decreased in pre-eclampsia and is worsened by decreasing blood pressure . Hydralazine , which causes vasodilatation , does not affect placental bed vessels . Calcium channel blockers ( like isradipine ) are vasodilators that do affect placental bed vessels and should improve blood flow even while decreasing blood pressure . The aim of the study was to determine if isradipine ( parenteral and oral ) was better than parenteral hydralazine and oral methyl dopa in severe pre-eclampsia in achieving better control of blood pressure . The study was a prospect i ve r and omised trial performed at The University Hospital of the West Indies . The sample consisted of 39 women with severe pre-eclampsia . Variables examined consisted of blood pressure before and after treatment , the increment in gestational age at delivery related to treatment , fetal Apgar score and birth weight . There were no significant differences in any of these variables between the two groups . Isradipine was as effective as hydralazine in reducing maternal blood pressure and in prolonging pregnancy The objective of this study was to evaluate the effectiveness of sublingual isosorbide dinitrate ( ID ) in the acute control of hypertension in patients with severe preeclampsia . A r and omized , double-blind clinical trial with a pre inclusion period of response to hydration and rest was performed in 60 patients with severe preeclampsia . The treatment group ( 30 patients ) received 5 mg of sublingual ID , a dose that could be repeated on a second occasion . The control group consisted of 30 patients who received placebo .  Both groups continued with rest and hydration during the study . Maternal blood pressure and fetal heart rate were measured in all patients every 10 min until 1 h was completed . Treatment was considered effective when the diastolic blood pressure could be reduced to between 80 and 100 mm Hg . ID was effective in 56.6 % of the patients in the first 10 min after its administration and in 96.6 % from 40 to 60 min . In the treatment group the systolic and diastolic blood pressures dropped gradually from 171 ± 13 and 113 ± 8 mm Hg , respectively , to 136 ± 14 and 87 ± 9 mm Hg . In the placebo group , blood pressure was not reduced . There was no significant difference in fetal heart rate between both groups throughout the study . In conclusion , ID was shown to be effective in the acute control of hypertension in patients with severe preeclampsia , where high blood pressure persists after a period of rest and hydration OBJECTIVES To compare ketanserin with hydralazine in the treatment of hypertension in late pregnancy . STUDY DESIGN R and omised control trial . Ten milligrams ketanserin were compared with 5 mg hydralazine , both given intravenously to 10 patients in each group .  Blood pressure , maternal and fetal heart rate and umbilical and arcuate artery Doppler flow velocimetry waveforms were recorded before and every 10 minutes after administration of the drug . RESULTS No significant differences were found between the two drugs in respect of initial blood pressures and readings taken 10 minutes after each 30-minute administration . One patient in the hydralazine group developed severe hypotension and fetal distress for which a caesarean section was performed . No change in the flow velocity waveforms of umbilical and arcuate arteries was noticed . CONCLUSION No unforeseen complications followed the administration of ketanserin . No major differences in the effects of the two drugs could be detected . Ketanserin appears to be safer as no hypotension occurred , and it reduced blood pressure more gradually . As ketanserin could become an alternative to hydralazine , more studies with larger numbers of patients are needed to compare it with hydralazine OBJECTIVE To establish the optimal dosage of ketanserin in the treatment of severe hypertension in pregnancy . STUDY DESIGN A double blind prospect i ve r and omised controlled trail , comparing 10 mg ketanserin given as intravenous boluses either every 10 or 20 min , until the therapeutic goal of 90 mmHg ( diastolic blood pressure ) was reached , to a maximum of eight boluses . Main outcome measures were treatment failures and caesarean sections for fetal distress . RESULTS There was no difference in reaching the therapeutic goal between patients receiving 10 mg ketanserin either every 10 or 20 min . CONCLUSION Ketanserin appears to be an attractive medicine in the treatment of  severe hypertension in pregnancy , but the optimal dosage could not be established 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 Summary : Doppler studies of the uterine and umbilical arteries were performed in 24 acutely hypertensive pregnant women . Women were divided into 2 groups : Group 1 ( diastolic blood pressure (DBP)>110 mm Hg ) received placebo ( n = 6 ) or 10 mg oral nifedipine ( n = 9 ) ; Group 2 ( DBP ≥ 110 mm Hg ) received 10 mg oral nifedipine ( n = 5 ) or 10 mg intravenous hydralazine ( n = 4 ) . Treatment allocations were r and om within groups and the investigator and patient were blind to the treatments . Baseline flow velocity waveforms ( FVW ) and posttreatment FVW 's at 30 , 60 and 120 minutes were recorded . There was no significant difference between baseline and posttreatment FVW indices within or between groups . Placebo was as effective as nifedipine in lowering blood pressure over 2 hours of study . There were no significant adverse effects of treatment The prospect i ve feasibility study was design ed to determine whether treatment with antithrombin ( AT ) concentrates could be used for patients with severe preeclampsia to provide clinical efficacy without the full systemic antihypertensive drug . Twenty-nine severe preeclamptic patients ( 24 to 36 weeks of gestation , gestosis index [ GI ] > /= 6 points ) were r and omized to receive AT ( 1500 U/day ) or not . AT was given intravenously once daily for 7 consecutive days . Twenty-four hours of continuous infusion of 5000 U/day of unfractionated heparin was given simultaneously in both groups . There were no statistical differences in the clinical profiles of the two groups . Maternal symptoms were evaluated from the difference of GI before and after treatment , and fetal findings were evaluated from the changes of the biophysical profile score . Improvement was significantly greater in the AT group for both the GI ( P = 0.046 ) and the biophysical profile score ( P = 0.022 ) . The improvement of coagulation parameters was also evaluated . The improvement of plasmin-plasmin inhibitor complex ( PPIC ) , D-dimer levels , and platelet counts was observed in the AT group compared with the non-AT group . The coagulation index as a composite coagulation test parameter showed a significantly improvement in the AT group . No adverse events related to AT were observed . Given that AT plus heparin was significantly better than treatment with heparin alone for improvement of both GI and biophysical profile of infant , it is suggested that therapy with AT alone might be effective enough for severe preeclampsia OBJECTIVE The purpose of this study was to determine whether the slower- and longer-acting nifedipine tablets were as effective and safe as the rapid onset and short-acting nifedipine capsules for the treatment of acute severe hypertension in pregnancy . STUDY DESIGN Sixty-four women in the second half of pregnancy who were not in labor r and omly received 10 mg nifedipine tablets ( n = 55 studies ) or 10 mg nifedipine capsules ( n = 74 studies ) if blood pressure was > or = 170/110 mm Hg . Blood pressure , heart rate , and cardiotocography were monitored over the subsequent 90 minutes . Successful treatment was a target blood pressure of 110 to 169/80 to 109 mm Hg after 90 minutes ; unsuccessful treatment included fetal distress at any stage , the requirement for additional treatment ( intravenous hydralazine ) , or the development of hypotension by 90 minutes after treatment . RESULTS Nifedipine capsules lowered blood pressure further ( 28/19 vs 21/13 mm Hg ; P = .03 ) than nifedipine tablets , but more than three quarters of each group had a successful treatment . Twice as many women ( 28 % ) who received nifedipine tablets required a second dose to achieve successful treatment ( P = .05 ) , but fewer women had hypotensive episodes ( P = .001 ) . Fetal distress was uncommon in both groups ( 3%-4 % ) , and both groups were delivered an average of 4 days after the study . CONCLUSION Nifedipine tablets , although of slower onset , are as effective as nifedipine capsules for the rapid treatment of severe hypertension in pregnancy Background . Pre‐eclampsia  is one of the most serious and common complications of pregnancy . Nifedipine , a calcium channel blocker , and the vasodilator hydralazine have both been used as antihypertensive agents in this condition . The aim of this study was to determine which of these two agents is the most appropriate antihypertensive in the management of severe pre‐eclampsia Objective To compare the haemodynamic efficacy of ketanserin ( a selective serotonin2‐receptor blocker ) with dihydralazine in the management of severe early‐onset hypertension in pregnancy We conducted a r and omized clinical trial in which patients with severe preeclampsia between 26 - 36 weeks of gestation received either nifedipine ( 10 - 30 mg sublingually , then 40 - 120 mg/day orally ; N=24 ) or hydralazine ( 6.25 - 12.5 mg intravenously , then 80 - 120 mg/day orally ; N=25 ) . Effective control of blood pressure was achieved with nifedipine in 95.8 % of subjects and with hydralazine in 68 % , a statistically significant difference ( P<.05 ) . Maternal side effects were minor in both groups . Acute fetal distress developed in one nifedipine subject and in 11 treated with hydralazine .  Mean prolongation of gestation was 15.5 ± 10 days with nifedipine and 9.5 ± 11 days with hydralazine , a difference that did not reach statistical significance ( P<.07 ) . Infants born to women treated with nifedipine were delivered at more advanced gestational ages ( 34.6 ± 2.3 versus 33.6 ± 2.4 weeks ; statistically not significant ) , weighed more ( 1826 ± 456 versus 1580 ± 499 g ; statistically not significant ) , and tended to have fewer , mainly minor , complications . The average number of days spent in the neonatal intensive care unit was significantly lower in the nifedipine group ( 15.1 versus 32.7 days ; P<.005 ) , leading to an average 31 % reduction in total ( maternal and neonatal ) hospitalization related charges for each nifedipine-treated pregnancy . We conclude that nifedipine is an effective , convenient , and low-cost treatment for patients with severe preeclampsia , and is not associated with undesirable side Prostagl and in A1 is a potent hypotensive , peripheral vasodilator , a weak oxytocic , antiplatelet aggregator . It improves the renal hemodynamics . Its effect on placental circulation was evaluated ( expressed as systolic/diastolic ratio and umbilical artery resistance index ) in 20 women with severe pre‐eclampsia and 10 normotensive pregnant women , by using the Doppler technique . Moreover , another 10 women with severe pre‐eclampsia received dextrose 5 % as a placebo for comparative purpose s. Significant improvements in both parameters studied were observed in the women with severe pre‐eclampsia . The beneficial changes differed significantly from the recorded values when using dextrose in pre‐eclampsia or prostagl and in A , in normotensive subjects . Such promising data add another important perspective to prostagl and in A , in severe pre‐eclampsia and may open up new avenues for its use in other situations with compromised placental flow OBJECTIVE Our purpose was to compare the hemodynamic effects of orally administered nifedipine and intravenously administered labetalol  in preeclamptic hypertensive emergencies . STUDY DESIGN Our study was a r and omized , double-blind evaluation of nifedipine and labetalol in women with preeclampsia and a systolic blood pressure > 170 mm Hg or a diastolic blood pressure > 105 mm Hg .  Nifedipine or labetalol and placebo were given , so patients received both tablet and intravenous solution . Hemodynamic parameters at dosing and at 15 , 30 , 60 , and 120 minutes were recorded . Outcome measures were cardiac index , systemic vascular resistance index , mean arterial pressure , and heart rate . Data were analyzed by repeated- measures analysis of variance ( Friedman test ) with Dunn posttests , the Mann-Whitney U test , and the chi(2 ) test with the Yates correction . Significance was set at P < .05 . RESULTS At dosing , the nifedipine group ( n = 6 ) had a cardiac index of 3.08 + /- 0.51 L/min per square meter . There was a 43 % increase in the cardiac index after nifedipine administration ( P = .0008 ) . There was no significant effect in the labetalol group ( P = .697 ) . There was a significant decrease in the systemic vascular resistance index after nifedipine dosing ( P = .002 ) but no significant effect on this index after labetalol use ( P = .479 ) . The mean arterial pressure was significantly affected in both groups as follows : nifedipine , P = . 001 ; labetalol , P = .004 . The post analysis showed significance at 60 minutes for both . An insignificant increase in heart rate with nifedipine ( P = .147 ) and a significant decrease with labetalol ( P = . 034 ) were noted . CONCLUSIONS Nifedipine increases cardiac index , whereas labetalol may not do so Patients with acute pregnancy-related hypertension were r and omized to treatment with 200 mg oral labetalol or 10 mg intramuscular hydralazine . Labetalol was found to be at least as effective , more predictable , more acceptable and produced no change in heart rate compared to hydralazine
target: Hydralazine was the most common drug for others to be evaluated against .
  Diazoxide , given as 75 mg bolus injections , appears to be associated with maternal hypotension requiring treatment , and ketanserin is less effective than hydralazine at reducing blood pressure .
  There is no other clear evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy .
  Exceptions are diazoxide and ketanserin , which are probably not good choices
background: BACKGROUND Very high blood pressure during pregnancy poses a serious threat to women and their babies .
  The use of drugs to lower blood pressure will reduce this risk for the women , and possibly also for the baby .
  OBJECTIVES The objective of this review was to compare different antihypertensive drugs used for treatment of severe hypertension during pregnancy .