Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review.
BACKGROUND
Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been most commonly studied, but oral agents would be ideal for use in busy and resource-constrained settings.


OBJECTIVE
To review systematically, the effectiveness of oral antihypertensive agents for treatment of severe pregnancy/postpartum hypertension.


METHODS
A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed.


METHODS
Randomised controlled trials in pregnancy and postpartum with at least one arm consisting of a single oral antihypertensive agent to treat systolic BP ≥ 160 mmHg and/or diastolic BP ≥ 110 mmHg.


METHODS
Cochrane RevMan 5.1 was used to calculate relative risk (RR) and weighted mean difference by random effects.


RESULTS
We identified 15 randomised controlled trials (915 women) in pregnancy and one postpartum trial. Most trials in pregnancy compared oral/sublingual nifedipine capsules (8-10 mg) with another agent, usually parenteral hydralazine or labetalol. Nifedipine achieved treatment success in most women, similar to hydralazine (84% with nifedipine; relative risk [RR] 1.07, 95% confidence interval [95% CI] 0.98-1.17) or labetalol (100% with nifedipine; RR 1.02, 95% CI 0.95-1.09). Less than 2% of women treated with nifedipine experienced hypotension. There were no differences in adverse maternal or fetal outcomes. Target BP was achieved ~ 50% of the time with oral labetalol (100 mg) or methyldopa (250 mg) (47% labetelol versus 56% methyldopa; RR 0.85 95% CI 0.54-1.33).


CONCLUSIONS
Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
T
T
Firoz
L A
LA
Magee
K
K
MacDonell
B A
BA
Payne
R
R
Gordon
M
M
Vidler
P
P
von Dadelszen
D000284:Administration, Oral; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy*; D007741:Labetalol / Q000008:administration & dosage; D008750:Methyldopa / Q000008:administration & dosage; D009543:Nifedipine / Q000008:administration & dosage; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D006830:Hydralazine; D008750:Methyldopa; D009543:Nifedipine; D007741:Labetalol
Antihypertensive therapy; hypertensive disorders of pregnancy; oral agents; pregnancy; severe hypertension