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Hydralazine Vs Nifedipine For Acute Hypertensive Emergency in Pregnancy: A Randomized Controlled Trial
Hydralazine Vs Nifedipine For Acute Hypertensive Emergency in Pregnancy: A Randomized Controlled Trial
Hydralazine Vs Nifedipine For Acute Hypertensive Emergency in Pregnancy: A Randomized Controlled Trial
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OBSTETRICS
Hydralazine vs nifedipine for acute hypertensive emergency
in pregnancy: a randomized controlled trial
Chanderdeep Sharma, MD (OBG), DNB (OBG); Anjali Soni, MD (OBG); Amit Gupta, MD (OBG); Ashok Verma, MD (OBG);
Suresh Verma, MD (OBG)
BACKGROUND: There is a paucity of good quality evidence regarding RESULTS: From December 2014 through September 2015, we
the best therapeutic option for acute control of blood pressure during acute enrolled 60 patients. The median time to achieve target blood pressure
hypertensive emergency of pregnancy. was 40 minutes in both groups (intravenous hydralazine and oral nifedi-
OBJECTIVE: We sought to compare the efficacy of intravenously pine) (interquartile interval 5 and 40 minutes, respectively, P ¼ .809). The
administered hydralazine and oral nifedipine for acute blood pressure median dose requirement in both groups was 2 (intravenous hydralazine
control in acute hypertensive emergency of pregnancy. and oral nifedipine) (interquartile range 1 and 2 doses, respectively, P ¼
STUDY DESIGN: In this double-blind, randomized, controlled trial, .625). Intravenous hydralazine was associated with statistically signifi-
pregnant women (24 weeks period of gestation) with sustained increase cantly higher occurrence of vomiting (9/30 vs 2/30, respectively, P ¼
in systolic blood pressure of 160 mm Hg or diastolic blood pressure of .042). No serious adverse maternal or perinatal side effects were wit-
110 mm Hg were randomized to receive intravenous hydralazine in- nessed in either group.
jection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral CONCLUSION: Both intravenous hydralazine and oral nifedipine are
nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection equally effective in lowering of blood pressure in acute hypertensive
every 20 minutes until the target blood pressure of 150 mm Hg systolic emergency of pregnancy.
and 100 mm Hg diastolic was achieved. Crossover treatment was
administered if the initial treatment failed. The primary outcome of the Key words: acute hypertensive emergency of pregnancy, blood
study was time necessary to achieve target blood pressure. The secondary pressure, critical care, double blind, hypertension, intravenous
outcomes were the number of dosages required, adverse maternal and hydralazine, maternal morbidity, maternal mortality, oral nifedipine,
neonatal effects, and perinatal outcome. preeclampsia
both intravenous hydralazine and oral hypertensive emergency in pregnancy: a updated guidelines for reporting parallel group
nifedipine. We preferred lower dosage of randomized controlled trial. Obstet Gynecol randomized trials. Obstet Gynecol 2010;115:
2013;122:1057-63. 1063-70.
hydralazine as initial dose (5 mg), and 2. ACOG Task Force. Hypertension in preg- 15. Barton JR, Hiett AK, Conover WB. The
subsequently it was followed by the nancy. Available at: https://www.acog.org/ use of nifedipine during the postpartum
higher dose (10 mg), as advised by the w/media/Task%20Force%20and%20Work% period in patients with severe preeclamp-
standard textbook by Cunningham 20Group%20Reports/public/Hypertensionin sia. Am J Obstet Gynecol 1990;162:
et al.23 Additionally, we followed the Pregnancy.pdf. Accessed May 28, 2017. 788-92.
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the dosage of nifedipine to have a flat nancy. Cochrane Database Syst Rev 2013;7: nifedipine in preeclamptic hypertensive emer-
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Shekhar et al1 that “oral nifedipine may
in acute hypertensive emergencies in preg- Author and article information
be preferred because of flat dosing nancy. S Afr Med J 1989;76:248-50. From the Dr Rajendra Prasad Government Medical
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References 331-7. The authors report no conflict of interest.
1. Shekhar S, Sharma C, Thakur S, Verma S. 14. Schulz KF, Altman DG, Moher D; for the Corresponding author: Chanderdeep Sharma, MD
Oral nifedipine or intravenous labetalol for CONSORT Group. CONSORT 2010 statement: (OBG), DNB (OBG). cdsharma2006@gmail.com