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#Grand Rounds

Labetalol or Nifedipine for Acute Elevated BP in Pregnancy?

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BACKGROUND AND PURPOSE:

  • Zulfeen et al. (European Journal of Obstetrics & Gynecology and Reproductive Biology, 2019) assessed the efficacy of IV labetalol compared to oral nifedipine for the treatment of severe hypertension in pregnancy

METHODS:

  • Parallel assignment double-blind randomized controlled trial (RCT)
  • Participants
    • Pregnant women >28 weeks gestation
    • Admitted with severe hypertension
      • Systolic BP of ≥160 mmHg and/or diastolic BP of ≥110 mmHg
      • On two separate occasions
      • 30 min apart in lateral recumbent position
  • Exposures
    • Labetalol group: 20 mg labetalol 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: 10 mg nifedipine initially followed by repeated doses of 20 mg every 15 min (total 5 doses) to a maximum of 90 mg
  • Primary outcome
    • Mean time take to achieve target BP of systolic 150 and /or diastolic 100 mmHg
  • Secondary outcomes
    • Number of doses required | Adverse effects | Maternal and perinatal outcome

RESULTS:

  • 120 women were included
    • 60 randomized to each group
  • No patients in the nifedipine group required labetalol | 3 patients in the labetalol group required nifedipine after maximum dose of labetalol
  • The average time to achieve the target BP was higher in the labetalol group
    • Labetalol: 36.75 min
    • Nifedipine: 27.25 min
    • mean difference 9.5 min (p=0.002)
  • Nifedipine was more likely to achieve target blood pressure
    • Hazard Ratio (HR) 1.8 (95% CI, 1.23 to 2.67)
  • The nifedipine group required significantly lower mean number of doses (p=0.002)
    • Labetalol: 2.45 doses
    • Nifedipine: 1.82 doses
  • Perinatal outcomes
    • Few adverse drug effects: Hypotension in nifedipine group (1) was transient and asymptomatic
    • No significant differences in maternal/fetal complications (however, small ‘n’)
  • Mean urine output (mL/hour) was higher in nifedipine group (66.82) vs labetalol group (55.08); p=0.001)

CONCLUSION:

  • Both labetalol and nifedipine effectively reduced blood pressure, though nifedipine had the following benefits
    • Lowered blood pressure more quickly
    • Was 1.8 times more likely to achieve target blood pressure
    • Maintained higher urine output
  • Authors suggest that

Oral nifedipine may be a better alternative due to its ease of oral administration and a flat dosing regimen.

Learn More – Primary Sources:

IV labetalol and oral nifedipine in acute control of severe hypertension in pregnancy–A randomized controlled trial

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Related ObG Topics:

ACOG Guidance: Emergency Treatment for Severe Hypertension in Pregnancy
Labetalol or Nifedipine for Chronic Hypertension in Pregnancy?
Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines
ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery

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