Drugs for treatment of very high blood pressure during pregnancy.
BACKGROUND
Very high blood pressure during pregnancy poses a serious threat to women and their babies. The use of drugs to lower blood pressure will reduce this risk for the women, and possibly also for the baby.


OBJECTIVE
The objective of this review was to compare different antihypertensive drugs used for treatment of severe hypertension during pregnancy.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group trials register (April 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2 2002) and MEDLINE (April 2002).


METHODS
Studies were randomised trials. Quasi random designs were excluded. Participants were women with severe hypertension during pregnancy. Women postpartum at trial entry were excluded. Interventions were any comparisons of one antihypertensive agent with another.


METHODS
Data were extracted independently by two reviewers to assess eligibility and describe the trial characteristics, and by one reviewer for the meta-analyses. Discrepancies were resolved by discussion. There was no blinding of authorship or results. Whenever possible, unpublished data were sought from investigators.


RESULTS
Twenty trials were included (1637 women) and 19 were excluded. There were ten different comparisons. Hydralazine was the most common drug for others to be evaluated against. Diazoxide, given as 75mg bolus injections, appears to be associated with maternal hypotension requiring treatment, and ketanserin is less effective than hydralazine at reducing blood pressure. There is no other clear evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy.


CONCLUSIONS
Until better evidence is available, the choice of antihypertensive should depend on the experience and familiarity of an individual clinician with a particular drug, and on what is known about adverse maternal and fetal side-effects. Exceptions are diazoxide and ketanserin, which are probably not good choices.
Duley
L
L
Resource Centre for Randomised Trials, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. lelia.duley@ndm.ox.ac.uk
Henderson-Smart
D J
DJ
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents