Antihypertensive therapy in patients with pre-eclampsia: A prospective randomised multicentre study comparing dihydralazine with urapidil.
BACKGROUND
Drug treatment is imperative for pregnant women with pregnancy-induced hypertension (PIH) and pre-eclampsia. For more than 40 years, dihydralazine has been the drug of choice for this indication. Another particularly effective and better tolerable antihypertensive is urapidil. Yet only a few studies on limited patient collectives have been published on the clinical experience with urapidil in PIH.


METHODS
Urapidil was interindividually compared to dihydralazine in a total of 42 patients, at six participating clinical centres. Patients were randomly assigned to the treatment groups. Urapidil was administered at an initial dose of 12.5-25mg, dihydralazine was administered at a uniform initial dose of 5mg. Patients were closely monitored for the initial 24h of therapy. Until delivery and in the postpartal phase, mother and baby underwent four additional follow-up checks at regular intervals.


RESULTS
Either drug was effective in lowering BP. Urapidil treatment proved to be better controllable. There were clear differences as to tolerability. In the urapidil group, one patient complained of headaches. In the dihydralazine group, six patients experienced adverse occurrences. Under dihydralazine treatment, some marked HR increases occurred, interpretable as reflectory tachycardia.


CONCLUSIONS
Urapidil proved to be equally effective as dihydralazine in lowering BP in patients with pre-eclampsia, but showed a better controllability and tolerability. Urapidil can hence be recommended as a promising alternative for patients with PIH.
Wacker
Juergen R
JR
Department of Obstetrics and Gynecology Bruchsal, Furst-Stirum-Klinik Bruchsal, Teaching Hospital of the University of Heidelberg, Gutleutstrasse 1-14, D-76646 Bruchsal, Baden Wuerttemberg, Germany. wacker.frauenklinik@krankenhaus-bruchsal.de
Wagner
Barbara K
BK
Briese
Volker
V
Schauf
Burkhard
B
Heilmann
Lothar
L
Bartz
Clemens
C
Hopp
Hartmut
H
D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure; D004078:Dihydralazine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D010879:Piperazines; C015568:urapidil; D004078:Dihydralazine