Nifedipine or prazosin as a second agent to control early severe hypertension in pregnancy: a randomised controlled trial.
OBJECTIVE
To determine whether nifedipine or prazosin is the more appropriate second-line antihypertensive agent in pregnancy.


METHODS
Randomised controlled trial.


METHODS
Tygerberg Hospital, a tertiary referral centre.


METHODS
Women with early, severe pre-eclampsia or hypertension in pregnancy, whose blood pressure could not be adequately controlled by methyldopa 2 g/day, but were otherwise stable.


METHODS
Nifedipine or prazosin were given and increased as necessary in a stepwise fashion. Once the maximum dose was reached, the other drug was added in a crossover pattern. Failure to control blood pressure, or the onset of maternal/fetal complications were indications for delivery. Patients reaching a minimum gestation of 34 weeks without complications were delivered electively.


METHODS
Antenatal days gained; major maternal complications and perinatal survival.


RESULTS
Days gained on the second antihypertensive agent did not differ significantly (P = 0.9), while more days were gained using nifedipine as the crossover 'third agent' (P = 0.01). In the nifedipine group better renal function was recorded, but more cases with isolated low platelet counts occurred. More cases of pulmonary oedema as well as more nonviable mid-trimester and third trimester intrauterine deaths occurred in the prazosin group.


CONCLUSIONS
Nifedipine and prazosin as second agents allowed comparable amounts of time to be gained, although this changed when used as crossover third-line agents. The efficacy and safety of nifedipine in this study are consistent with the results of other studies. A greater number of intrauterine deaths occurred in the prazosin group.
Hall
D R
DR
Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, South Africa.
Odendaal
H J
HJ
Steyn
D W
DW
Smith
M
M
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D009543:Nifedipine / Q000627:therapeutic use*; D011224:Prazosin / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000503:physiopathology; D011256:Pregnancy Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009543:Nifedipine; D011224:Prazosin