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The Cochrane Database of Systematic... Jul 2013Very high blood pressure during pregnancy poses a serious threat to women and their babies. The aim of antihypertensive therapy is to lower blood pressure quickly but... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Very high blood pressure during pregnancy poses a serious threat to women and their babies. The aim of antihypertensive therapy is to lower blood pressure quickly but safety, to avoid complications. Antihypertensive drugs lower blood pressure but their comparative effectiveness and safety, and impact on other substantive outcomes is uncertain.
OBJECTIVES
To compare different antihypertensive drugs for very high blood pressure during pregnancy.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (9 January 2013).
SELECTION CRITERIA
Studies were randomised trials. Participants were women with severe hypertension during pregnancy. Interventions were comparisons of one antihypertensive drug with another.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors extracted data and checked them for accuracy.
MAIN RESULTS
Thirty-five trials (3573 women) with 15 comparisons were included. Women allocated calcium channel blockers were less likely to have persistent high blood pressure compared to those allocated hydralazine (six trials, 313 women; 8% versus 22%; risk ratio (RR) 0.37, 95% confidence interval (CI) 0.21 to 0.66). Ketanserin was associated with more persistent high blood pressure than hydralazine (three trials, 180 women; 27% versus 6%; RR 4.79, 95% CI 1.95 to 11.73), but fewer side-effects (three trials, 120 women; RR 0.32, 95% CI 0.19 to 0.53) and a lower risk of HELLP (haemolysis, elevated liver enzymes and lowered platelets) syndrome (one trial, 44 women; RR 0.20, 95% CI 0.05 to 0.81).Labetalol was associated with a lower risk of hypotension compared to diazoxide (one trial 90 women; RR 0.06, 95% CI 0.00 to 0.99) and a lower risk of caesarean section (RR 0.43, 95% CI 0.18 to 1.02), although both were borderline for statistical significance.Both nimodipine and magnesium sulphate were associated with a high incidence of persistent high blood pressure, but this risk was lower for nimodipine compared to magnesium sulphate (one trial, 1650 women; 47% versus 65%; RR 0.84, 95% CI 0.76 to 0.93). Nimodipine was associated with a lower risk of respiratory difficulties (RR 0.28, 95% CI 0.08 to 0.99), fewer side-effects (RR 0.68, 95% CI 0.55 to 0.85) and less postpartum haemorrhage (RR 0.41, 95% CI 0.18 to 0.92) than magnesium sulphate. Stillbirths and neonatal deaths were not reported.There are insufficient data for reliable conclusions about the comparative effects of any other drugs.
AUTHORS' CONCLUSIONS
Until better evidence is available the choice of antihypertensive should depend on the clinician's experience and familiarity with a particular drug; on what is known about adverse effects; and on women's preferences. Exceptions are nimodipine, magnesium sulphate (although this is indicated for women who require an anticonvulsant for prevention or treatment of eclampsia), diazoxide and ketanserin, which are probably best avoided.
Topics: Antihypertensive Agents; Calcium Channel Blockers; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 23900968
DOI: 10.1002/14651858.CD001449.pub3 -
The Cochrane Database of Systematic... Jul 2006Very high blood pressure during pregnancy poses a serious threat to women and their babies. Antihypertensive drugs lower blood pressure. Their comparative effects on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Very high blood pressure during pregnancy poses a serious threat to women and their babies. Antihypertensive drugs lower blood pressure. Their comparative effects on other substantive outcomes, however, is uncertain.
OBJECTIVES
To compare different antihypertensive drugs for very high blood pressure during pregnancy.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (28 February 2006) and CENTRAL (The Cochrane Library 2006, Issue 2).
SELECTION CRITERIA
Studies were randomised trials. Participants were women with severe hypertension during pregnancy. Interventions were comparisons of one antihypertensive drug with another.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data.
MAIN RESULTS
Twenty-four trials (2949 women) with 12 comparisons were included. Women allocated calcium channel blockers rather than hydralazine were less likely to have persistent high blood (five trials, 263 women; 6% versus 18%; relative risk (RR) 0.33, 95% confidence interval (CI) 0.15 to 0.70). Ketanserin was associated with more persistent high blood pressure than hydralazine (four trials, 200 women; 27% versus 6%; RR 4.79, 95% CI 1.95 to 11.73), but fewer side-effects (three trials, 120 women; RR 0.32, 95% CI 0.19 to 0.53) and a lower risk of HELLP (Haemolysis, Elevated Liver enzymes and Lowered Platelets) syndrome (one trial, 44 women, RR 0.20, 95% CI 0.05 to 0.81). Labetalol was associated with a higher risk of hypotension (one trial 90 women; RR 0.06, 95% CI 0.00 to 0.99) and caesarean section (RR 0.43, 95% CI 0.18 to 1.02) than diazoxide. Data were insufficient for reliable conclusions about other outcomes. The risk of persistent high blood pressure was greater for nimodipine compared to magnesium sulphate (two trials 1683 women; 47% versus 65%; RR 0.84, 95% CI 0.76 to 0.93). Nimodipine was also associated with a higher risk of eclampsia (RR 2.24, 95% CI 1.06 to 4.73) and respiratory difficulties (RR 0.28, 95% CI 0.08 to 0.99), but fewer side-effects (RR 0.68, 95% CI 0.54 to 0.86) and less postpartum haemorrhage (RR 0.41, 95% CI 0.18 to 0.92) than magnesium sulphate. Stillbirths and neonatal deaths were not reported. There are insufficient data for reliable conclusions about the comparative effects of any other drugs.
AUTHORS' CONCLUSIONS
Until better evidence is available, the choice of antihypertensive should depend on the clinician's experience and familiarity with a particular drug, and on what is known about adverse effects. Exceptions are diazoxide, ketanserin, nimodipine and magnesium sulphate, which are probably best avoided.
Topics: Antihypertensive Agents; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 16855969
DOI: 10.1002/14651858.CD001449.pub2 -
The Cochrane Database of Systematic... 2002Very high blood pressure during pregnancy poses a serious threat to women and their babies. The use of drugs to lower blood pressure will reduce this risk for the women,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Very high blood pressure during pregnancy poses a serious threat to women and their babies. The use of drugs to lower blood pressure will reduce this risk for the women, and possibly also for the baby.
OBJECTIVES
The objective of this review was to compare different antihypertensive drugs used for treatment of severe hypertension during pregnancy.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register (April 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2 2002) and MEDLINE (April 2002).
SELECTION CRITERIA
Studies were randomised trials. Quasi random designs were excluded. Participants were women with severe hypertension during pregnancy. Women postpartum at trial entry were excluded. Interventions were any comparisons of one antihypertensive agent with another.
DATA COLLECTION AND ANALYSIS
Data were extracted independently by two reviewers to assess eligibility and describe the trial characteristics, and by one reviewer for the meta-analyses. Discrepancies were resolved by discussion. There was no blinding of authorship or results. Whenever possible, unpublished data were sought from investigators.
MAIN RESULTS
Twenty trials were included (1637 women) and 19 were excluded. There were ten different comparisons. Hydralazine was the most common drug for others to be evaluated against. Diazoxide, given as 75mg bolus injections, appears to be associated with maternal hypotension requiring treatment, and ketanserin is less effective than hydralazine at reducing blood pressure. There is no other clear evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy.
REVIEWER'S CONCLUSIONS
Until better evidence is available, the choice of antihypertensive should depend on the experience and familiarity of an individual clinician with a particular drug, and on what is known about adverse maternal and fetal side-effects. Exceptions are diazoxide and ketanserin, which are probably not good choices.
Topics: Antihypertensive Agents; Female; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Randomized Controlled Trials as Topic
PubMed: 12519557
DOI: 10.1002/14651858.CD001449 -
The Cochrane Database of Systematic... 2000Very high blood pressure during pregnancy poses a serious threat to women and their fetuses. The use of drugs to lower blood pressure may reduce this risk. (Review)
Review
BACKGROUND
Very high blood pressure during pregnancy poses a serious threat to women and their fetuses. The use of drugs to lower blood pressure may reduce this risk.
OBJECTIVES
The objective of this review was to compare different antihypertensive drugs used for rapid treatment of severe hypertension during pregnancy.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register.
STUDIES
All randomised trials. Quasi random designs were excluded.
PARTICIPANTS
Women with severe hypertension during pregnancy. Women postpartum at trial entry were excluded.
INTERVENTIONS
Comparisons of one antihypertensive agent with another.
OUTCOMES
For the women: blood pressure control, eclampsia, serious maternal morbidity (such as kidney failure and liver failure), Caesarean section, and use of health service resources (such as admission to hospital or intensive care unit). For the baby: death, serious neonatal morbidity, infant and child development, and use of health service resources (such as admission to a special care nursery).
DATA COLLECTION AND ANALYSIS
Data were extracted independently by two reviewers to assess eligibility and describe the trial characteristics, and by one reviewer for the meta-analyses. Discrepancies were resolved by discussion. There was no blinding of authorship or results. Whenever possible, unpublished data were sought from investigators.
MAIN RESULTS
Thirteen of the 14 trials included in this review were small (range 19-627 women). Of the eight comparisons, five included hydralazine. Diazoxide given as 75mg bolus injections appears to be associated with profound hypotension requiring treatment, and ketanserin is less effective than hydralazine at reducing blood pressure. There is no other evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy.
REVIEWER'S CONCLUSIONS
Until better evidence is available, the choice of antihypertensive should depend on the experience and familiarity of an individual clinician with a particular drug, and on what is known about adverse maternal and fetal side-effects. Exceptions are diazoxide and ketanserin, which are probably not good choices.
Topics: Antihypertensive Agents; Female; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 10796261
DOI: 10.1002/14651858.CD001449