title: Ketanserin versus dihydralazine for the treatment of severe hypertension in early-onset preeclampsia: a double blind randomized controlled trial.
abstract: OBJECTIVE
  Determine the definitive position of ketanserin and dihydralazine for treatment of severe hypertension in pregnancy.
  
  
  METHODS
  A single centre double blind randomized controlled trial was performed at the obstetrical tertiary high care unit of the University Medical Centre in Rotterdam, the Netherlands. Women with severe hypertension in pregnancy (diastolic blood pressure (DBP)≥110mmHg), and significant proteinuria (≥300mg/24h), and gestational age≤32 weeks were eligible for the study. All patients (n=30) received two infusions (double dummy technique): one contained the active ingredient (ketanserin or dihydralazine), the other was used for placebo. Nicardipine was used as rescue medication. The main outcome measures were persistent severe hypertension (DBP>100mmHg>120min) despite maximum dosage of study medication and prolongation of pregnancy.
  
  
  RESULTS
  Dihydralazine was significantly more effective in lowering blood pressure than ketanserin. No significant difference in prolongation of pregnancy was seen between the two groups. After 30 inclusions, the study was stopped because of the high rate of persistent hypertension using ketanserin and the high rate of maternal side effects using dihydralazine and the apparent succesful use of the rescue drug nicardipine.
  
  
  CONCLUSIONS
  Our results do not support the use of either dihydralazine or ketanserin for the treatment of severe hypertension in pregnancy. Future research is needed to compare nicardipine with other antihypertensive drugs currently in use for treatment of severe hypertension in pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands. Electronic address: s.w.a.nijbijvank@isala.nl.
authors.forename: Sebastiaan W Nij
authors.initials: SW
authors.lastname: Bijvank
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Willy
authors.initials: W
authors.lastname: Visser
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Duvekot
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Department of Clinical Epidemiology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Mireille A
authors.initials: MA
authors.lastname: Edens
authors.affiliation: Department of Neonatology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Danielle W
authors.initials: DW
authors.lastname: Roofthooft
authors.affiliation: Department of Hospital Pharmacy, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Vulto
authors.affiliation: Department of Hospital Pharmacy, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Lidwien M
authors.initials: LM
authors.lastname: Hanff
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004078:Dihydralazine / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007650:Ketanserin / Q000009:adverse effects / Q000627:therapeutic use*; D009426:Netherlands; D009529:Nicardipine / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*
chemical_list: D000959:Antihypertensive Agents; D007650:Ketanserin; D009529:Nicardipine; D004078:Dihydralazine
keywords: Dihydralazine; Ketanserin; Nicardipine; Pregnancy; Severe hypertension