title: Dihydralazine or ketanserin for severe hypertension in pregnancy? Preliminary results.
abstract: OBJECTIVE
  To compare the efficacy and safety of intravenous dihydralazine with ketanserin in the management of severe hypertension in the third trimester.
  
  
  METHODS
  A double blind randomised 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Tygerberg Hospital, South Africa. dws@maties.sun.ac.za
authors.forename: D W
authors.initials: DW
authors.lastname: Steyn
authors.forename: H J
authors.initials: HJ
authors.lastname: Odendaal
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D004078:Dihydralazine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005313:Fetal Death / Q000139:chemically induced; D005316:Fetal Distress / Q000139:chemically induced; D006340:Heart Rate, Fetal; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007650:Ketanserin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*
chemical_list: D000959:Antihypertensive Agents; D007650:Ketanserin; D004078:Dihydralazine