To compare the efficacy of intravenous labetalol with oral nifedipine in the treatment of severe hypertension in pregnancy with blood pressure ≥160/110 mm Hg.
Design, setting and participants
We conducted a parallel double-blinded randomized controlled trial between December 2014 to December 2016 in 120 antenatal women of gestational age >28 weeks, admitted with severe hypertension of blood pressure ≥160/110 mm Hg to maternity ward at a tertiary hospital.
The labetalol group received 20 mg initially followed by escalating doses of 40 mg, 80 mg, 80 mg and 80 mg (5 doses) every 15 min to a maximum of 300 mg. Nifedipine group received 10 mg initially followed by repeated doses of 20 mg every 15 min (total 5 doses) to a maximum of 90 mg. Vital signs were recorded every 15 min.
-The time taken and the number of doses required to achieve the target blood pressure (150/100 mmHg). Survival analysis was used to compare the efficacy of treatment regimens.
Sixty women were randomised to each group and none were lost to follow-up. None of the patients in nifedipine group required labetalol, whereas three patients in labetalol group achieved target BP only after receiving nifedipine was administered after the maximum dose of labetalol.The mean time taken to achieve the target blood pressure in the labetalol group was higher (36.75 min) than in the nifedipine group (27.25 min) [mean difference 9.5 min,p = 0.002]. Nifedipine group required significantly lower doses (1.82 ± 0.83) as compared to labetalol (2.45 ± 1.32) [p = 0.002]. Nifedipine was 1.8 times more likely to achieve target blood pressure (Hazard Ratio = 1.8).
Both intravenous Labetalol and oral Nifedipine were effective in controlling blood pressure. Nifedipine reduced BP more rapidly than Labetalol. Oral Nifedipine may be a better alternative because of its ease of oral administration and a flat dosing regimen.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Hypertensive disorders of pregnancy.J Prenat Med. 2009; 3: 1
- National Institute for Health and Clinical Excellence (NICE). Hypertension in Pregnancy: the management of hypertensive disorders during pregnancy.NICE Clin. Guideline. 2010; 107: 1-295
- Australasian Society for the Study of Hypertension in Pregnancy. Management of hypertension in pregnancy [consensus statement].1993: 1 (Melbourne, Australia)
- Report of the Canadian hypertension society consensus conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy.Can Med Assoc J. 1997; 157: 1245-1254
- Antihypertensive drug therapy for mild to moderate hypertension during pregnancy.Cochrane Database Syst Rev. 2018; (Art. No.: CD002252)https://doi.org/10.1002/14651858.CD002252.pub4
- Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis.BJOG. 2016; 123: 40-47
- Report of the national high blood pressure education pro-gram working group on high blood pressure in pregnancy. NIH publication No. 00-3029, July.2000 (Accessible at)www.nhlbi.nih.gov/health/prof/heart/hbp_preg.htm
- Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis.Lancet. 2000; 355 (22): 87-92
- A randomized, double blind trial of oral nifedipine and intravenous labetalol in hypertensive emergencies of pregnancy.Am J Obstet Gynecol. 1999; 181: 858-861
- Nifedipine in pregnancy.Bjog Int J Obstet Gynaecol. 2000; 107: 299-307
- Committee on obstetric practice. Committee opinion no. 692: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period.Obstet Gynecol. 2017; 129: e90
- WHO reproductive health library.WHO recommendation on antihypertensive drugs for women with severe hypertension during pregnancy (October 2011). The WHO Reproductive Health Library. World Health Organization, Geneva2019
- Nifedipine in the treatment of severe preeclampsia.Obstet Gynecol. 1991; 77: 331-337
- A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complication pregnancy.Obstet Gynecol. 1987; 70: 328-333
- Diagnosis and management of atypical preeclampsia-eclampsia.Am J Obstet Gynecol. 2009; 200: e1
- Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy: a randomized controlled trial.Obstet Gynecol. 2013; 122: 1057-1063
- Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomised trial.BJOG. 2012; 119: 78-85
- Drugs for treating severe hypertension in pregnancy: a network meta‐analysis and trial sequential analysis of randomized clinical trials.Br J Clin Pharmacol. 2018; 84: 1906-1916
- Oral nifedipine versus intravenous labetalol for the treatment of severe hypertension in pregnancy.Int J Cardiol. 2015; 178: 162-164
- What are Hazard Ratios.Hayward Medical Communications, London2009
- A comparative evaluation of intravenous labetalol versus oral nifedipine for control of severe pregnancy-induced hypertension with low-dose regimen.Int J Med Sci Public Health. 2016; 5 (Online First)
- Oral nifedipine versus intravenous labetalol in hypertensive urgencies and emergencies of pregnancy: a randomized clinical trial.Obstet Med. 2012; 5: 171-175
- A randomized trial of intravenous labetalol & oral nifedipine in severe pregnancy induced hypertension.Int J Reprod Contracept Obstet Gynecol. 2012; 1: 42-46
- Assessment of safety and efficacy of oral nifedipine and intravenous labetalol in management of increased blood pressure in severe preeclampsia.Int J Reprod Contracept Obstet Gynecol. 2018; 7: 2645-2649
- Oral nifedipine versus intravenous labetalol in hypertensive emergencies of pregnancy: a randomised trial.Res J Pharm Biol Chem Sci. 2015; 6: 1673-1681
- Comparative study of intravenous labetalol and oral nifedipine for control of blood pressure in severe preeclampsia.2019
- The use of nifedipine during the postpartum period in patients with severe preeclampsia.Am J Obtet Gynecol. 1990; 162: 788-792
- American College of Obstetricians and Gynecologists, task force on hypertension in pregnancy. Hypertension in pregnancy. Report of the American college of obstetricians and gynecologists’ task force on hypertension in pregnancy.Obstet Gynecol. 2013; 122: 1122
- Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium related maternal side effects in women with preeclampsia.Am J Obstet Gynecol. 2005; 193: 153-163
- Antihypertensive treatment.in: Roberts J.M. Cunningham F.G. Lindheimer M.D. Chesley’s hypertensive disorders in pregnancy. 3rd ed. Academic Press, San Diego (CA)2009: 369-387
- The effect of sublingual nifedipine on uteroplacental blood flow in hypertensive pregnancy.Br J Obstet Gynaecol. 1988; 95: 1276-1281
- Uterine and fetal flow velocity waveforms in hypertensive pregnancy: the effect of single dose nifedipine.Obstet Gynecol. 1990; 76: 36-41
- Treatment of severe pregnancy associated with hypertension with the calcium antagonist nifedipine.Br J Obstet Gynaecol. 1987; 91: 330-334
Published online: March 05, 2019
Accepted: January 20, 2019
Received in revised form: January 17, 2019
Received: July 30, 2018
© 2019 Elsevier B.V. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Erratum to “IV labetalol and oral nifedipine in acute control of severe hypertension in pregnancy–A randomized controlled trial” [Eur. J. Obstet. Gynecol. Reprod. Biol. 236 (May) (2019) 46–52]European Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 247