Title: Comparative Evaluation of Efficacy & Safety of Intravenous Labetalol and Oral Nifedipine in Severe Hypertension of Pregnancy
Authors: Dr Dibya Singh, Dr Shikha Singh, Prof. Saroj Singh, Dr Rekha Rani, Dr Urvashi Vrema, Dr Ashwini Kumar Nigam, Dr Neeraj Yadav
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.104
Abstract
Objective: Comparative evaluation of efficacy of intravenous labetalol and oral nifedipine in severe hypertention in pregnancy.
Design: Prospective Randamised trial
Setting: S.N. medical college, Agra
Population: Pregnant women with severe hypertension≥160/110 mmHg who required immediate treatment.
Methods: Patients were randomised using random table in to two groups. Group A:40 patients received intravenous labetalol injection(in escalating dose regime 20,40,80,80 and 80 mg).Group B:40 patients received oral Nifedipine (in escalating doses 10, 20,20,20 and 20mg)every 20 minutes until the target blood pressure of ≤160/110 mmHg was achieved or maximum 5 doses used. MAIN OUTCOME MEASURE The time taken to achieve a blood pressure of ≤160/110 mmHg and doses required.
Results: 38(95%)/40 in labelalol group & 40/40 in nifedipine group showed control of adequate control of blood pressure. Difference is not significant(0.331)The median time taken to achieve target blood pressure was 29.5+11.8 and 43.68+16.7 minutes for nifedipine and labetalol, respectively (P=0.00007). Mean systolic and diastolic blood pressure reduction with nifedipine at after first dose was 17.03+7.36 mmhg and 10.75+6.87mmhg respectively. .Mean systolic and diastolic blood pressure reduction with labetalol after first dose was 13.65+5.37 mmhg and 8.6+3.23mmhg respectively. Average no. of doses required with labetalol was significantly more (p=0.00005) than nifedipine. There was no significant difference between both the groups regarding systolic(p=0.465) and diastolic(p=0.08) blood pressure at 24 hours after control of blood pressure.
Conclusions: Both drugs effectively control blood pressure in severe hypertention in pregnancy.
Keywords: Preeaclampsia, Labetalol,Nifedipine.
1. Cunningham FG,Lenovo KJ,Bloom SL, Hauth JC,Rouse DJ,Spong CY,section7 obstetrical complications. Hypertensive Disorders of pregnancy.In:Twickler D, Wendel et all, editors Williams obstetrics, 23rd edition, New York: McGraw- Hill Medical Publushing division;2010 ;706-711.
2. Duley L.The global effect of pre-eclampsia and eclampsia. Seminars in Perinatology, 2009 jun;33(3):130-137.
3. Steegers EA,von Dadelszen P,Duvkot JJ, Pijnenborg R.Pre-eclampsia. Lancet, 2010,21;376(9741):631-44
4. Dolea C,AbouZahr C. WHO evidence and information for policy. Global Burden of hypertensive disorders of pregnancy in year 2000;1-2
5. National High Blood Pressure Education Programme Working Group on high blood pressure in pregnancy.Am J Obstet Gynacol 2000;183:S1-S22.
6. Sathya Lakshmi S,Dasari P . Oral nifedipine versus intravenous labetalol in hypertensive urgencies and emergencies of pregnancy. A Randomized Clinical Trial. Obstet Med Dec 2012 Vol.5.no 4;171-175.
7. Dhali B et al.Intravenous labetalol and oral nifedipine in severe pregnancy induced hypertension.A randomised trial.Int J Report Contracept Obstet Gynecol.2012 Dec;1(1):42-46
8. Raheem IA,Saaid R,Omar SZ,Tan PC.Oral nifedipine versus intravenous labetalol for acute blood pressure control in hyperte-nsive emergencies of pregnancy:a randomized trial.BJOG 2011; DOI:10.1111/j.1471-0528.2011.03151.x.
9. ACOG. Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33, American College of Obstetricians and Gynecolo-gists. Obstet Gynecol 2002 ; 99 : 159 - 67.
10. Duley L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br. J. Obstet Gynaecol 1992 ; 99 : 547 - 53.
11. Sibai BM, Frangieh AY. Management of severe preeclampsia. Curr Opin Obstet Gynecol 1996 ; 8 : 110 - 3.
12. Magee LA. Elran E, Bull SB, Logan LA, Korean G. Risks and benefits of beta-receptive blockers for pregnancy hypertension : overview of the randomized trials. Eur J Obstet Gynecol Reprod Biol 2000 ; 88 : 15 - 26.
13. Scardo JA, Vermillion ST, Newman RB, Chauhan SP, Hogg BB. A randomized, double blind, hemodynamic evaluation of nifedipine and labetalol in preeclamptic hypertensive emergencies. Am. J. Obstet Gynecol. 1999 ; 181 : 862-6.
14. Wachter RM. Symptomatic hypotension induced by nifedipine in the acute treatment of severe hypertension. Arch Intern Med. 1987 ; 147 : 556 - 58.
15. O' Malia JJ, Sander GE, Giles TD. Nifedipine associated myocardial ischemia or infarction in the treatment of severe hypertension. Arch Intern Med. 1987; 147: 556 - 558.