Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial.
OBJECTIVE
The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy.


METHODS
Two hundred women with severe hypertension in pregnancy were randomized to receive hydralazine (5 mg as a slow bolus dose given intravenously, and repeated every 20 min up to a maximum of five doses) or labetalol (20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min, followed by 80 mg every 20 min up to a maximum dose of 300 mg). The primary end point was successful lowering of blood pressure and maternal hypotension.


RESULTS
Women were similar with respect to characteristics at randomization. No significant differences were observed for maternal hypotension or persistent severe hypertension; only two patients in the hydralazine group presented with hypotension. Palpitations (p=0.01) and maternal tachycardia (p=0.05) occurred significantly more often in patients treated with hydralazine. The main neonatal outcomes were very similar per group; however, hypotension and bradycardia were significantly more frequent in the labetalol group. There were two neonatal deaths per antihypertensive drug group.


CONCLUSIONS
This randomized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy.
Vigil-De Gracia
Paulino
P
The Obstetric Intensive Unit, Department of Gynecology and Obstetrics, Complejo Hospitalario "Arnulfo Arias Madrid" Caja de Seguro Social, Apartado Postal 87 32 24, Zona 7, Panamá, Panama. pvigil-d@cwp.net.pa
Lasso
Martin
M
Ruiz
Esteban
E
Vega-Malek
Juan Carlos
JC
de Mena
Flor Tem
FT
López
Juan Carlos
JC
D018674:Adrenergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced; D007741:Labetalol / Q000008:administration & dosage / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D013610:Tachycardia / Q000139:chemically induced; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D018674:Adrenergic Antagonists; D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D006830:Hydralazine; D007741:Labetalol