Dihydralazine or ketanserin for severe hypertension in pregnancy? Preliminary results.
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.
Steyn
D W
DW
Department of Obstetrics and Gynaecology, Tygerberg Hospital, South Africa. dws@maties.sun.ac.za
Odendaal
H J
HJ
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*
D000959:Antihypertensive Agents; D007650:Ketanserin; D004078:Dihydralazine