D R Hall1, H J Odendaal, D W Steyn, M Smith. 1. Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, South Africa.
Abstract
OBJECTIVE: To determine whether nifedipine or prazosin is the more appropriate second-line antihypertensive agent in pregnancy. DESIGN: Randomised controlled trial. SETTING:Tygerberg Hospital, a tertiary referral centre. POPULATION: Women with early, severe pre-eclampsia or hypertension in pregnancy, whose blood pressure could not be adequately controlled by methyldopa 2 g/day, but were otherwise stable. METHODS:Nifedipine or prazosin were given and increased as necessary in a stepwise fashion. Once the maximum dose was reached, the other drug was added in a crossover pattern. Failure to control blood pressure, or the onset of maternal/fetal complications were indications for delivery. Patients reaching a minimum gestation of 34 weeks without complications were delivered electively. MAIN OUTCOME MEASURES: Antenatal days gained; major maternal complications and perinatal survival. RESULTS: Days gained on the second antihypertensive agent did not differ significantly (P = 0.9), while more days were gained using nifedipine as the crossover 'third agent' (P = 0.01). In the nifedipine group better renal function was recorded, but more cases with isolated low platelet counts occurred. More cases of pulmonary oedema as well as more nonviable mid-trimester and third trimester intrauterine deaths occurred in the prazosin group. CONCLUSION:Nifedipine and prazosin as second agents allowed comparable amounts of time to be gained, although this changed when used as crossover third-line agents. The efficacy and safety of nifedipine in this study are consistent with the results of other studies. A greater number of intrauterine deaths occurred in the prazosin group.
RCT Entities:
OBJECTIVE: To determine whether nifedipine or prazosin is the more appropriate second-line antihypertensive agent in pregnancy. DESIGN: Randomised controlled trial. SETTING: Tygerberg Hospital, a tertiary referral centre. POPULATION: Women with early, severe pre-eclampsia or hypertension in pregnancy, whose blood pressure could not be adequately controlled by methyldopa 2 g/day, but were otherwise stable. METHODS:Nifedipine or prazosin were given and increased as necessary in a stepwise fashion. Once the maximum dose was reached, the other drug was added in a crossover pattern. Failure to control blood pressure, or the onset of maternal/fetal complications were indications for delivery. Patients reaching a minimum gestation of 34 weeks without complications were delivered electively. MAIN OUTCOME MEASURES: Antenatal days gained; major maternal complications and perinatal survival. RESULTS: Days gained on the second antihypertensive agent did not differ significantly (P = 0.9), while more days were gained using nifedipine as the crossover 'third agent' (P = 0.01). In the nifedipine group better renal function was recorded, but more cases with isolated low platelet counts occurred. More cases of pulmonary oedema as well as more nonviable mid-trimester and third trimester intrauterine deaths occurred in the prazosin group. CONCLUSION:Nifedipine and prazosin as second agents allowed comparable amounts of time to be gained, although this changed when used as crossover third-line agents. The efficacy and safety of nifedipine in this study are consistent with the results of other studies. A greater number of intrauterine deaths occurred in the prazosin group.
Authors: Catherine A Fitton; Markus F C Steiner; Lorna Aucott; Jill P Pell; Daniel F Mackay; Michael Fleming; James S McLay Journal: J Hypertens Date: 2017-11 Impact factor: 4.844
Authors: M V B Malachias; C E P Figueiredo; N Sass; I C Antonello; M R Torloni; M R F L Bortolotto Journal: Arq Bras Cardiol Date: 2016-09 Impact factor: 2.000
Authors: Louise M Webster; Frances Conti-Ramsden; Paul T Seed; Andrew J Webb; Catherine Nelson-Piercy; Lucy C Chappell Journal: J Am Heart Assoc Date: 2017-05-17 Impact factor: 5.501