BMJ  2003;327:955 (25 October), doi:10.1136/bmj.327.7421.955

Paper

Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis

¹ University of British Columbia, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC, Canada V6H 3N1, ² Faculty of Medicine, University of British Columbia, Vancouver, ³ Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada M5G 1X5 Canadian Cochrane Network and Centre

Objective To review outcomes in randomised controlled trials comparing hydralazine against other antihypertensives for severe hypertension in pregnancy.

Study design Meta-analysis of randomised controlled trials (published between 1966 and September 2002) of short acting antihypertensives for severe hypertension in pregnancy. Independent data abstraction by two reviewers. Data were entered into RevMan software for analysis (fixed effects model, relative risk and 95% confidence interval); in a secondary analysis, risk difference was also calculated.

Results Of 21 trials (893 women), eight compared hydralazine with nifedipine and five with labetalol. Hydralazine was associated with a trend towards less persistent severe hypertension than labetalol (relative risk 0.29 (95% confidence interval 0.08 to 1.04); two trials), but more severe hypertension than nifedipine or isradipine (1.41 (0.95 to 2.09); four trials); there was significant heterogeneity in outcome between trials and differences in methodological quality. Hydralazine was associated with more maternal hypotension (3.29 (1.50 to 7.23); 13 trials); more caesarean sections (1.30 (1.08 to 1.59); 14 trials); more placental abruption (4.17 (1.19 to 14.28); five trials); more maternal oliguria (4.00 (1.22 to 12.50); three trials); more adverse effects on fetal heart rate (2.04 (1.32 to 3.16); 12 trials); and more low Apgar scores at one minute (2.70 (1.27 to 5.88); three trials). For all but Apgar scores, analysis by risk difference showed heterogeneity between trials. Hydralazine was associated with more maternal side effects (1.50 (1.16 to 1.94); 12 trials) and with less neonatal bradycardia than labetalol (risk difference -0.24 (-0.42 to -0.06); three trials).

Conclusions The results are not robust enough to guide clinical practice, but they do not support use of hydralazine as first line for treatment of severe hypertension in pregnancy. Adequately powered clinical trials are needed, with a comparison of labetalol and nifedipine showing the most promise.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Management of pre-eclampsia

Lelia Duley, Shireen Meher, and Edgardo Abalos
BMJ 2006 332: 463-468. [Extract] [Full Text] [PDF]

Hydralazine is not the best antihypertensive in pregnancy
BMJ 2003 327: 0. [Full Text]

This article has been cited by other articles:

• McCoy, S., Baldwin, K. (2009). Pharmacotherapeutic options for the treatment of preeclampsia. Am J Health Syst Pharm 66: 337-344 [Abstract] [Full text]  
• Presbitero, P., Boccuzzi, G. G., Groot, C. J.M., Roos-Hesselink, J. W. (2009). CHAPTER 33 Pregnancy and Heart Disease. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full text]  
• Podymow, T., August, P. (2008). Update on the Use of Antihypertensive Drugs in Pregnancy. Hypertension 51: 960-969 [Full text]  
• Powrie, R. O. (2007). A 30-Year-Old Woman With Chronic Hypertension Trying to Conceive. JAMA 298: 1548-1558 [Abstract] [Full text]  
• Marik, P. E., Varon, J. (2007). Hypertensive Crises: Challenges and Management. Chest 131: 1949-1962 [Abstract] [Full text]  
• Bolton, L. B., Donaldson, N. E., Rutledge, D. N., Bennett, C., Brown, D. S. (2007). The Impact of Nursing Interventions: Overview of Effective Interventions, Outcomes, Measures, and Priorities for Future Research. Med Care Res Rev 64: 123S-143S [Abstract]  
• Duley, L., Meher, S., Abalos, E. (2006). Management of pre-eclampsia.. BMJ 332: 463-468 [Full text]  
• Malik, I. (2004). JournalScan. Heart 90: 117-118 [Full text]  
• (2003). Is Hydralazine Optimal Therapy for Severe Hypertension During Pregnancy?. Journal Watch Cardiology 2003: 7-7 [Full text]  
• (2003). Is Hydralazine Optimal Therapy for Severe Hypertension During Pregnancy?. JWatch General 2003: 4-4 [Full text]  

Online poll

Find out more >>