Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review

Authors

  • T Firoz,

    1. Department of Medicine, University of British Columbia, Vancouver, BC, Canada
    2. Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author
  • LA Magee,

    Corresponding author
    1. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
    2. Department of Medicine, British Columbia Women's Hospital and Health Sciences Centre, Vancouver, BC, Canada
    • Correspondence: LA Magee, Room IU59, BC Women's Hospital, 4500 Oak Street, Vancouver, BC V6N 3N1, Canada. Email LMagee@cw.bc.ca

    Search for more papers by this author
  • K MacDonell,

    1. College of Physicians & Surgeons of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author
  • BA Payne,

    1. Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
    2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author
  • R Gordon,

    1. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author
  • M Vidler,

    1. Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
    2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author
  • P von Dadelszen,

    1. Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
    2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
    Search for more papers by this author
  • and for the Community Level Interventions for Pre-eclampsia (CLIP) Working Group


  • Linked article This article is commented on by Norton ME, p 1220 in this issue. To view this mini commentary visit http://dx.doi.org/10.1111/1471-0528.12738. The article has journal club questions by Duffy JMN, p.1219 in this issue.

Abstract

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.

Objectives

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

Search strategy

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

Selection criteria

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.

Data collection and analysis

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

Main 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.

Ancillary