Comparison of the alpha and beta blocking drug, labetalol, and methyl dopa in the treatment of moderate and severe pregnancy-induced hypertension. PLACEBO-CONTROLLED TRIAL OF ATENOLOL IN TREATMENT OF PREGNANCY-ASSOCIATED HYPERTENSION A randomised comparison of hydralazine and mini-bolus diazoxide for hypertensive emergencies in pregnancy: the PIVOT trial. A PROSPECTIVE CONTROLLED TRIAL OF METOPROLOL‐HYDRALAZINE TREATMENT IN HYPERTENSION DURING PREGNANCY Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial. Ketanserin versus dihydralazine for the treatment of severe hypertension in early-onset preeclampsia: a double blind randomized controlled trial. [Chronic high blood pressure in 110 pregnant women]. l-Arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications Atenolol and fetal growth in pregnancies complicated by hypertension. A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial Multivitamin supplementation of HIV-positive women during pregnancy reduces hypertension. Early blood pressure control improves pregnancy outcome in primigravid women with mild hypertension. Comparison of the efficacy of nifedipine and hydralazine in hypertensive crisis in pregnancy. 24-hour ambulatory blood pressure monitoring: a comparison between transdermal glyceryl-trinitrate and oral nifedipine. Atenolol in essential hypertension during pregnancy. Stress and Blood Pressure During Pregnancy: Racial Differences and Associations With Birthweight Effects of guided imagery on blood pressure in pregnant women with hypertension: a pilot randomized controlled trial. Vitamin C and E Supplementation Does Not Reduce the Risk of Superimposed PE in Pregnancy Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials Treatment of hypertension in patients with pre-eclampsia: a prospective parallel-group study comparing dihydralazine with urapidil. Validity in nulliparas of increased beta-human chorionic gonadotrophin at mid-term for predicting pregnancy-induced hypertension complicated with proteinuria and intrauterine growth retardation. A randomized comparison of early with conservative use of antihypertensive drugs in the management of pregnancy‐induced hypertension
Twentysix women with pregnancy-induced hypertension have been r and omly treated with either labetalol or Aldomet . A more satisfactory control of blood pressure was obtained with labetalol with minimal side-effects . After two weeks of treatment with labetalol  renal function had significantly improved with a markedly lower incidence of proteinuria . More patients went into spontaneous labour following labetalol than following Aldomet ; the Bishop score was also higher in this group . No adverse effects attributable to labetalol were noted in the baby either ante- or post-natally Atenolol was compared with placebo in a r and omised and double-blind prospect i ve study of 120 women with mild to moderate pregnancy-associated hypertension who were also initially managed conventionally by bed rest .  Atenolol given once daily significantly reduced blood-pressure , prevented proteinuria , and reduced the number of hospital admissions . Loss of blood-pressure control leading to withdrawal from the study was commoner among the placebo group , whose babies had a high morbidity . Respiratory distress syndrome occurred only in the placebo group . Intrauterine growth retardation , neonatal hypoglycaemia , and hyperbilirubinaemia occurred with the same frequency in the two groups . Neonatal bradycardia was more common after atenolol but the systolic blood-pressure of the babies was the same in both groups . There was no difference between the groups in maternal symptoms which could have been attributed to beta-blocker therapy . Thus atenolol is more effective than conventional obstetric management in this form of hypertension and does not adversely affect mother or baby AIMS Diazoxide is one of few available agents for treatment of hypertensive emergencies in pregnancy . From previous studies , there is a question concerning safety after moderate-dose administration caused episodes of hypotension . Rapid control of severe hypertension is necessary to reduce maternal morbidity , for example , stroke and placental abruption . This study was design ed to compare the efficacy of mini-bolus diazoxide with intravenous ( i.v . ) hydralazine . DESIGN A r and omised controlled trial . SETTING Tertiary referral maternity hospital , Royal Prince Alfred Women and Babies , Sydney Australia . POPULATION Antenatal and postnatal women with severe hypertension . METHODS One hundred and twenty-four hypertensive women were r and omised to either i.v . hydralazine ( 5 mg doses ) or  mini-bolus diazoxide  ( 15 mg doses ) . PRIMARY OUTCOME MEASURE Achievement of target blood pressure reduction ; secondary measures included requirement for Caesarean section because of fetal deterioration as determined by non-reassuring cardiotocograph ( CTG ) . RESULTS Reduction in systolic and diastolic blood pressure was 34 min for hydralazine and 19 min for diazoxide ( P < 0.001 ) . There were no episodes of hypotension after diazoxide and one after hydralazine ( after epidural ) . Episodes of persistent severe hypertension were more common with hydralazine ( 38 % ) than with diazoxide ( 16 % ) , P < 0.01 . The Caesarean section rate for no-reassuring CTG was no different between the two groups . Neonatal outcomes were similar . CONCLUSION Diazoxide and hydralazine are safe and effective antihypertensives , showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy . The mini-bolus doses of 15 mg of diazoxide did not precipitate maternal hypotension as previously described and reduces episodes of persistent severe hypertension Abstract . in an open , controlled trial , treatment with a combination of metoprolol and hydralazine was compared with non‐pharmacological management of mild and moderate hypertension in pregnancy . One hundred and sixty‐one women participated in the study . the drug‐treated group showed significantly better blood pressure control than the group not given antihypertensives .  Induction of labor before term , because of maternal or fetal complications , was somewhat more frequent in the control group . Nine women in the treatment group and 5 in the control group developed albuminuria . Three infants in the drug‐treated group died perinatally , and one in the control group . the outcome for the newborns was similar in both groups concerning birth weight , head circumference and Apgar score and in the frequencies of respiratory distress , bradycardia and hypoglycemia . the better blood pressure control achieved with these drugs makes it possible to treat the patient at home and reduce the risk of emergency delivery , but treatment does not seem to be m and atory for a good outcome of the pregnancy in cases of mild and moderate hypertension during pregnancy OBJECTIVE The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy . STUDY DESIGN Two hundred women with severe hypertension in pregnancy were r and omized to receive hydralazine ( 5 mg as a slow bolus dose given intravenously , and repeated every 20 min up to a maximum of five doses ) or labetalol ( 20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min , followed by 80 mg every 20 min up to a maximum dose of 300 mg ) . The primary end point was successful lowering of blood pressure and maternal hypotension . RESULTS Women were similar with respect to characteristics at r and omization . No significant differences were observed for maternal hypotension or persistent severe hypertension ; only two patients in the hydralazine group presented with hypotension . Palpitations ( p=0.01 ) and maternal tachycardia ( p=0.05 ) occurred significantly more often in patients treated with hydralazine . The main neonatal outcomes were very similar per group ; however , hypotension and bradycardia were significantly more frequent in the labetalol group . There were two neonatal deaths per antihypertensive drug group . CONCLUSIONS This r and omized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy OBJECTIVE Determine the definitive position of ketanserin and dihydralazine for treatment of  severe hypertension in pregnancy . STUDY DESIGN A single centre double blind r and omized controlled trial was performed at the obstetrical tertiary high care unit of the University Medical Centre in Rotterdam , the Netherl and s. Women with severe hypertension in pregnancy ( diastolic blood pressure (DBP)≥110mmHg ) , and significant proteinuria ( ≥300mg/24h ) , and gestational age≤32 weeks were eligible for the study . All patients ( n=30 ) received two infusions ( double dummy technique ) : one contained the active ingredient ( ketanserin or dihydralazine ) , the other was used for placebo . Nicardipine was used as rescue medication . The main outcome measures were persistent severe hypertension ( DBP>100mmHg>120min ) despite maximum dosage of study medication and prolongation of pregnancy . RESULTS Dihydralazine was significantly more effective in lowering blood pressure than ketanserin . No significant difference in prolongation of pregnancy was seen between the two groups . After 30 inclusion s , the study was stopped because of the high rate of persistent hypertension using ketanserin and the high rate of maternal side effects using dihydralazine and the apparent succesful use of the rescue drug nicardipine . CONCLUSIONS Our results do not support the use of either dihydralazine or ketanserin for the treatment of severe hypertension in pregnancy . Future research is needed to compare nicardipine with other antihypertensive drugs currently in use for treatment of severe hypertension in pregnancy BACKGROUND Hypertension is associated with increased maternal and fetal mortality and morbidity . While there is consensus that severe hypertension should be treated , antihypertensive treatment for mild chronic hypertension during pregnancy remains controversial . OBJECTIVE To evaluate clinical course , and maternal and perinatal outcomes of pregnant women with mild chronic hypertension without other disease , under strict control of maternal hypertension ( target dBP of 85 - 89 mmHg ) . PATIENTS AND METHODS We conducted a prospect i ve cohort study of 110 pregnant women with mild chronic hypertension without other disease ; clinical course was classified in three groups : stable condition , exacerbation of hypertension and superimposed preeclampsia . We compare maternal and perinatal outcomes ; statistical comparisons were performed by ANOVA test . Relative risk ( RR ) was calculated for adverse perinatal outcomes . RESULTS Atotal of 110 women were included , mean maternal age was 33 + /- 5.8 years . There were 78 ( 71 % ) women with stable condition , 26 ( 24 % ) with exacerbation of hypertension and 6 ( 5 % ) with superimposed preeclampsia ( PE ) . Women with superimposed PE and exacerbation of hypertension delivered earlier and had more small for gestational age ( SGA ) babies than women with stable condition and exacerbation . Delivery route was vaginal in 45 patients ( 40 % ) while 65 patients ( 60 % ) underwent cesarean section in order to avoid fetal distress . CONCLUSIONS Results demonstrated that fetuses in the stable condition group ( strict control ) did not have worst outcomes than those in the other groups . This cohort study shows efficacy and safety of treating mild chronic hypertension during pregnancy Objective . To evaluate l-arginine ( l-Arg ) supplementation in pregnant women with chronic hypertension and its effects on blood pressure ( BP ) and maternal and neonatal complications . Methods . We enrolled 80 women affected by mild chronic hypertension referred to the High Risk Clinic of the Mother – Infant Department of the University of Modena and Reggio Emilia . Each woman after obtaining oral consent was r and omized to receive oral l-Arg versus placebo and thereafter su bmi tted to 24-h ambulatory BP monitoring . The primary outcome was BP change after 10–12 weeks of treatment . Secondary outcomes were as follows : percentage of women on antihypertensive treatment at delivery , maternal , and fetal outcome . Results . The BP changes after 10–12 weeks of treatment did not differ between groups . A lower percentage of women received antihypertensive drugs in the l-Arg group than the placebo group . The incidence of superimposed preeclampsia indicated delivery before the 34th weeks and certain neonatal complications tended to be higher in the placebo group . Conclusions . l-Arg supplementation in pregnant women with mild chronic hypertension does not significantly affect overall BP but is associated with less need for antihypertensive medications and a trend toward fewer maternal and neonatal complications . The results of the study were limited by the small sample size and by the exclusion of women with severe chronic hypertension . In our policy , these patients needed many hypertensive drugs and were normally managed by the cardiologist . Nevertheless , considering the promising results on maternal and fetal outcome , we believe that further studies should be performed to confirm such data and to clarify the role of l-Arg as a protective supplement in high-risk pregnancy Atenolol use may be associated with growth retardation when given in pregnancy , although the relationship to trimester of initiation , duration of treatment , and its use as monotherapy is still uncertain . To compare the obstetric and fetal outcome between women receiving atenolol ( as monotherapy ) and other antihypertensive drug monotherapies , and also to investigate the effect of duration of treatment on fetal growth , we performed a retrospective cohort study of 312 pregnancies in 223 women attending an Antenatal Hypertension Clinic .  Atenolol ( as monotherapy ) was given in 78 pregnancies ( 25.0 % ) , other types of antihypertensive drugs as monotherapy were given in 53 pregnancies ( 17.0 % ) , and multiple drug combinations were given in 90 pregnancies ( 28.8 % ) . In 91 pregnancies ( 29.2 % ) no antihypertensive drugs were given . Atenolol was found to be associated with lower birth weight and ponderal index values , with a trend toward a higher prevalence of preterm ( < 37 weeks ) delivery and small-for-gestational-age babies when compared to other antihypertensive drugs as monotherapy , or to no treatment . The adverse effect of atenolol  was more pronounced in women receiving the drug earlier in their pregnancy , and continuing the drug for a longer duration . In conclusion , atenolol should be avoided in the early stages of pregnancy and given with caution at the later stages , as it is associated with fetal growth retardation , which is related to duration of treatment OBJECTIVE To compare the antihypertensive effects of epoprostenol sodium ( prostacyclin ) with that of dihydralazine in acute hypertensive crises of pregnancy . DESIGN A prospect i ve r and omized study . A minimum of 20 patients per group was considered statistically acceptable ( alpha = 0.05 , power = 0.9 ) . SETTING A large urban tertiary hospital . SUBJECTS Forty-seven pregnant patients with diastolic blood pressures of > 100 mmHg were studied . INTERVENTION Lowering of high blood pressure with either dihydralazine ( n = 25 ) , the st and ard drug for this purpose , or epoprostenol ( n = 22 ) . MAIN OUTCOME MEASURE A significant drop in high blood pressure was regarded as a fall of 15 mmHg diastolic and 30 mmHg systolic blood pressure . RESULTS There were no statistically significant differences in the antihypertensive effects between the two treatment groups . Epoprostenol infusion caused less tachycardia ; the mean pulse rate changed from 81.77 beats/min , before treatment to 88.36 at stabilization , compared with a change from 80.96 beats/min to 102.68 in the group treated with dihydralazine ( P = 0.0024 ) . CONCLUSION The place of epoprostenol in pregnancy might be in patients with severe hypertension and tachycardia and in those requiring acute control of severe hypertension on the operating table before general anaesthesia Background Changes during the puerperium are still unclear , particularly in women with hypertension . The choice of antihypertensives , both to control very high blood pressure episodes and to keep blood pressure stable , also requires further elucidation . Currently , there are no clear data to guide the decision for the choice of postpartum antihypertensives . Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum . Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to  captopril , with satisfactory effect . The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension . Methods and findings A r and omized , drug-controlled , triple-blind clinical trial evaluating postpartum women  receiving captopril or clonidine . Inclusion criteria consisted of : women with hypertensive disorders of pregnancy systolic blood pressure ( SBP ) ≥180 mmHg and /or diastolic blood pressure ( DBP ) ≥110 mmHg ] , requiring magnesium sulfate . Exclusion criteria were : heart disease , smoking , illicit drug use , contraindications to captopril , clonidine or oral medication , and having used captopril/clonidine previously . The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit .  A total of 90 postpartum women met the study inclusion criteria , with 45 r and omized to each group . There were fewer very high blood pressure episodes during hospitalization ( 2.1 ± 2.1 vs. 3.5 ± 4.7 , p = 0.08 ) , greater percentage reduction in SBP ( 14.0 % ± 8.6 % vs. 10.8 % ± 8.8 % , p = 0.08 ) and fewer women requiring sodium nitroprusside ( 2.3 % vs. 13.3 % ; RR : 0.17 ; 95%CI : 0.02–1.39 ; p = 0.06 ) in the clonidine group compared to the captopril group ; however , these differences were not significant . The groups were similar regarding daily mean SBP or DBP ; however , on the third postpartum day , mean SBP was lower in the clonidine compared to the captopril group ( 151.9 ± 11.8 mmHg vs. 158.1 ± 13.6 mmHg , p = 0.02 ) . Although not statistically significant , adverse reactions were more common in the captopril group ( 28.8 % ) compared to the clonidine group ( 18.6 % ) . Conclusion Clonidine and captopril represent safe , effective treatments for severe postpartum hypertension . Trial registration clinical trials.gov : www . clinical trial.gov , NCT01761916 Hypertension during pregnancy increases fetal growth retardation , preterm deliveries , and perinatal deaths , and yet its causes remain unclear . In HIV-infected women , preterm birth additionally increases the risk of HIV transmission to the infant . Oxidative stress and endothelial cell dysfunction of the placenta have been implicated in the development of hypertension during pregnancy . Vitamin intake can reduce oxidative stress and improve endothelial function . We therefore evaluated the effect of multivitamin ( 20 mg thiamine , 20 mg riboflavin , 25 mg B-6 , 50 microg B-12 , 500 mg C , 30 mg E , and 0.8 mg folic acid ) and vitamin A supplements ( 30 mg beta-carotene plus 5000 IU preformed vitamin A ) in relation to hypertension during pregnancy ( systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg at any time during pregnancy ) . In a double-blind , placebo-controlled , r and omized , clinical trial , conducted among 1078 HIV-positive pregnant Tanzanian women , those who received multivitamins were 38 % less likely to develop hypertension during pregnancy than those who did not [ relative risk ( RR ) = 0.62 , 95 % CI 0.40 - 0.94 , P = 0.03 ] . There was no overall effect of vitamin A on hypertension during pregnancy ( RR = 1.00 , 95 % CI 0.66 - 1.51 , P = 0.98 ) . Hypertension during pregnancy was more likely in women with high baseline systolic blood pressure ( > 120 vs. < or = 120 mm Hg ) ( RR = 6.02 , 95%CI 2.59 - 13.97 , P < 0.001 ) , and those with higher mid-upper arm circumference ( RR = 1.12 , 95 % CI 1.04 - 1.19 , P = 0.002 ) . Taking multivitamins containing vitamins B , C , and E during pregnancy may be an inexpensive and effective strategy to improve the health of the mother and baby OBJECTIVE AND DESIGN The aim of this study was to evaluate treatment of mild to moderate hypertension ( less than 170/110 mmHg ) in pregnancy in a prospect i ve , r and omised , double-blind trial . SETTING AND PATIENTS Pregnancy outcome was studied for 52 primigravid women , managed in hospital from early in the third trimester . INTERVENTIONS Patients were r and omly allocated either to placebo or to active treatment ( clonidine plus hydralazine ) . MAIN OUTCOME MEASURES AND RESULTS Maternal deterioration dictated withdrawal from trial therapy for eight patients receiving placebo , but for only one receiving active treatment . Maternal proteinuria occurred only in the placebo group . Intention-to-treat analysis showed a significant increase in premature delivery for complications in the placebo group ( P less than 0.05 ) , despite active blood pressure treatment for those withdrawn from the group because of severe hypertension ( 170/110 mmHg or higher ) . Neonatal respiratory distress requiring intensive care occurred only in babies born to women in the placebo group . There were no perinatal deaths and no adverse effects of treatment in the neonates . CONCLUSIONS The study indicates that early control of mild hypertension in pregnancy can prevent progression to emergency premature delivery Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy . Oral nifedipine is an alternative in management of these patients . In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients . Fifty hypertensive pregnant women were enrolled in the study . A r and omized clinical trial was performed , in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction . The primary outcomes measured were the time and doses required for desired blood pressure achievement . Secondary measures included urinary output and maternal and neonatal side effects . The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group ( 24.0 ± 10.0 min ) than intravenus Hydralazine group ( 34.8 ± 18.8 min ) ( P ≤ 0.016 ) . Less frequent doses were required with oral nifedipine ( 1.2 ± 0.5 ) compared to intravenus hydralazine ( 2.1 ± 1.0 ) ( P ≤ 0.0005 ) . There were no episodes of hypotension after hydralazine and one after nifedipine . Nifedipine and hydralazine are safe and effective antihypertensive drugs , showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy . Both drugs reduce episodes of persistent severe hypertension . Considering pharmacokinetic properties of nifedipine such as rapid onset and long duration of action , the good oral bioavailability and less frequent side effects , it looks more preferable in hypertension emergencies of pregnancy than hydralazine The objective of the present study is to compare the effectiveness of transdermal glyceryl-trinitrate versus oral nifedipine in lowering blood pressure in patients affected by pregnancy-induced hypertension ( PIH ) . Thirty-six consecutive pregnant women have been evaluated at different gestational ages after the diagnosis of PIH or preeclampsia ( PE ) . After a 24-h ambulatory blood pressure monitoring , patients were allocated to three groups : those receiving oral nifedipine and those receiving transdermal glyceryl-trinitrate in a continuous ( 24 h/day ) or intermittent ( 16 h/day ) administration . A second blood pressure monitoring was performed after 2 weeks of treatment . Systolic and diastolic blood pressure were compared by using the Cosinor method looking at mesor , amplitude , and acrophase . Baseline systolic and diastolic blood pressure was similar among the three groups . Neither the transdermal glyceryl-trinitrate administered for 24 or 16 h nor oral nifedipine affected systolic and diastolic blood pressure . Analysis of variance showed that the posttreatment values were similar among the groups . Further studies are needed to verify the possible use of transdermal glyceryl-trinitrate as an antihypertensive drug during pregnancy OBJECTIVE --To determine the effect of atenolol on the outcome of pregnancy in women with essential hypertension . DESIGN -- Prospect i ve , r and omised , double blind , placebo controlled study . SETTING --Hospital clinic . PATIENTS --33 Women with mild essential hypertension ( systolic blood pressure 140 - 170 mm Hg or diastolic pressure 90 - 110 mm Hg on two occasions at least 24 hours apart ) consecutively referred to two obstetric medical clinics . Four patients in the  placebo group were withdrawn from the study : control of blood pressure was inadequate in two , one developed breathlessness , and one changed her mind about participating . The mean gestation in the 29 remaining women on entry to the study was 15.9 weeks . MAIN OUTCOME MEASURES --Blood pressure and birth weight . INTERVENTION--14 Women received placebo . 15 Women received atenolol 50 mg daily initially , increasing until either the blood pressure was less than 140/90 mm Hg or a dose of 200 micrograms daily was reached . RESULTS --The mean blood pressure on entry was 148/86 mm Hg in the group given atenolol and 144/86 mm Hg in the group given placebo . During treatment the mean diastolic pressure was significantly reduced by atenolol compared with placebo ( to 74 v 81 mm Hg ; difference in means ( 95 % confidence interval ) 7.0 ( 2.9 to 10.0 ) mm Hg ) but the effect on systolic pressure was marginal ( 132 v 136 mm Hg ; 4.0 ( -1.4 to 8.6 ) mm Hg ) . Babies in the atenolol group had a significantly lower birth weight than those in the placebo group ( 2620 g v 3530 g ; 910 ( 440 to 1380)g ) . CONCLUSION --Atenolol given from the end of the first trimester in patients with mild hypertension is associated with intrauterine growth retardation . When taken in conjunction with the results of a previous study in which methyldopa was given these findings indicate that benefit is unlikely to result from treating mild essential hypertension in pregnancy Objective : To extend findings that African American women report greater stress during pregnancy , have higher blood pressure ( BP ) , and are twice as likely to have low birthweight infants relative to white women . This study examines a ) racial differences in associations between stress and BP during pregnancy , and b ) the combined effects of stress and BP on infant birthweight in a sample of 170 African American and white women . Methods : A prospect i ve , longitudinal study of pregnant women was conducted in which measures of  BP , stress  , and other relevant variables were collected . Multiple measures of systolic and diastolic BP  were taken at each of three points during pregnancy ( 18–20 , 24–26 , and 30–32 weeks gestation ) . Results : Both systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) were positively associated with stress in pregnant African American women and not in pregnant white women . In analyses of birthweight , there were no main effects of BP or stress . However , a significant interaction demonstrated that , when stress was high , DBP was negatively associated with birthweight and a combination of high stress and high DBP predicted the lowest birthweight in the sample . Furthermore , African American women were twice as likely as white women to have a combination of high stress and high DBP . Conclusions : Racial differences in relationships between stress and BP , and the interactive effect of stress and DBP on birthweight together suggest that a high stress-high BP profile may pose a risk for lower birthweight among African American women , in particular , and possibly for all pregnant women . BP = blood pressure ; DBP = diastolic blood pressure ; SBP = systolic blood pressure ; BMI = body mass index ; Ms = means BACKGROUND Hypertension occurs in nearly 10 percent of pregnancies , and is associated with higher risk of infant and maternal morbidity and mortality than in normal pregnancies . Previous studies have suggested that relaxation therapies reduce blood pressure in nonpregnant adults . The objectives of this pilot r and omized trial were to provide preliminary evidence of whether relaxation by means of guided imagery would reduce blood pressure in hypertensive pregnant women , and to assess the feasibility of a larger trial . METHODS A total of 69 pregnant women with hypertension were r and omized to periods of guided imagery or of quiet rest , twice daily for 4 weeks or until delivery , whichever came first . Daytime ambulatory mean arterial pressure , systolic and diastolic blood pressure , and anxiety were measured weekly for up to 4 weeks . RESULTS Women allocated to guided imagery had lower mean arterial pressure elevations over time than those allocated to quiet rest ( guided imagery : M = 1.58 mmHg , SD = 7.63 ; quiet rest : M = 5.93 mmHg , SD = 6.55 ; t = 2.36 , p = 0.02 ) . However , when adjusted for baseline mean arterial pressure and gestation , the effect was not significant ( p = 0.14 ) . Numbers of women prescribed antihypertensive medication postr and omization were similar ( guided imagery : n = 16 ; quiet rest : n = 13 , χ(2 ) = 0.74 , p = 0.46 ) . There was also no evidence of an effect on women 's anxiety . Nearly 90 percent ( n = 26 ) of the guided imagery group indicated that they would use it again . CONCLUSIONS Further rigorous study is warranted to determine effects of guided imagery on maternal blood pressure and perinatal health outcomes Background . Oxidative stress could play a role in the development of preeclampsia . There is some evidence to suggest that vitamin C and E supplements can reduce the risk of the disorder . We hypothesized its beneficial role in a group of pregnant women with essential hypertension . Methods . In this r and omized controlled trial , we enrolled 50 pregnant women with essential hypertension . We assigned the women 1000 mg vitamin C and 400 IU natural vitamin E ( RRR α tocopherol ; n = 25 ) , daily from the second trimester of pregnancy until delivery or no supplementation ( n = 25 ) . Our primary endpoint was development of superimposed preeclampsia , and main secondary endpoints were aggravation of hypertension , need for admission , need to increase antihypertensive drugs , and small size for gestational age ( < fifth customized birthweight centile ) . Results . We analyzed 50 women who completed the study .  The incidence of superimposed preeclampsia was similar in vitamin and control groups ( 8 % [ n = 2 ] vs 12 % [ n = 3 ] , p = 1.000 ) . Vitamin C and E supplementation also did not prevent aggravation of hypertension in group of women who took it ( 12 % [ n = 3 ] vs 32 % [ n = 8 ] , p = 0.172 ) . Small size for gestational age babies did not differ between groups ( 4 % [ n = 2 ] vs 6 % [ n = 3 ] , p = 1.000 ) . Conclusion . Vitamin C and E supplementation does not prevent development of superimposed preeclampsia in women with essential hypertension . Our results did not show any significant benefit of vitamin supplementation . There was some trend in lessening of hypertensive complications of pregnancy . Our results failed to find any correlation between development of superimposed preeclampsia and oxidative stress Introduction Self-monitoring of blood pressure ( BP ) in pregnancy could improve the detection and management of pregnancy hypertension , while also empowering and engaging women in their own care . Two linked trials aim to evaluate whether BP self-monitoring in pregnancy improves the detection of raised BP during higher risk pregnancies ( BUMP 1 ) and whether self-monitoring reduces systolic BP during hypertensive pregnancy ( BUMP 2 ) . Methods and analyses Both are multicentre , non-masked , parallel group , r and omised controlled trials . Participants will be r and omised to self-monitoring with telemonitoring or usual care . BUMP 1 will recruit a minimum of 2262 pregnant women at higher risk of pregnancy hypertension and BUMP 2 will recruit a minimum of 512 pregnant women with either gestational or chronic hypertension . The BUMP 1 primary outcome is the time to the first recording of raised BP by a healthcare professional . The BUMP 2 primary outcome is mean systolic BP between baseline and delivery recorded by healthcare professionals . Other outcomes will include maternal and perinatal outcomes , quality of life and adverse events . An economic evaluation of BP self-monitoring in addition to usual care compared with usual care alone will be assessed across both study population s within trial and with modelling to estimate long-term cost-effectiveness . A linked process evaluation will combine quantitative and qualitative data to examine how BP self-monitoring in pregnancy is implemented and accepted in both daily life and routine clinical practice . Ethics and dissemination The trials have been approved by a Research Ethics Committee ( 17/WM/0241 ) and relevant research authorities . They will be published in peer- review ed journals and presented at national and international conferences . If shown to be effective , BP self-monitoring would be applicable to a large population of pregnant women . Trial registration number BACKGROUND The primary objective of treatment in women with severe hypertension and pre-eclampsia is to prevent complications such as encephalopathy and haemorrhage . In many countries dihydralazine is considered the drug of choice for treating hypertension in pregnancy , because it now has been used safely for about 30 years , and the introduction of a new drug in pregnancy is a difficult task with partially unknown hazards . In some other countries combined alpha- and beta-blockers are also used . Taking into account that some patients with pre-eclampsia do not respond to dihydralazine and the drug has serious side-effects like headache and reflex tachycardia , there is some need for developing alternative treatment strategies using drugs that are more adequate for pregnancy than dihydralazine . METHODS Urapidil is a post-synaptic alpha 1 adrenoceptor antagonist , which is widely used to control hypertensive crises unrelated to pregnancy . Since it is known that pre-eclampsia is associated with increased sympathetic activity , administration of an alpha 1 adrenoceptor antagonist provides a reasonable therapeutic basis . So far there is only one report describing the i.v . use of urapidil in the treatment of hypertension in pregnancy unresponsive to dihydralazine and one report which describes the oral use of urapidil . In an earlier pilot study we examined the dose range for i.v . application of urapidil necessary for adequate blood pressure control in patients with pre-eclampsia . In the present r and omized controlled study 26 white women with pre-eclampsia and hypertension in pregnancy were included . Treatment was not blinded . During the initial period of intensive intravenous treatment all subjects were under constant surveillance by a physician and a nurse . RESULTS Effective prolonged control of blood pressure ( values below 150/100 mmHg ) was achieved in all patients of the two groups . In one patient of the dihydralazine group signs of lightheadedness and near syncope were noted . After this side-effect of dihydralazine the patient was treated with urapidil . At the end of the observation period the maternal heart rate in the dihydralazine group was higher than in the urapidil group . CONCLUSIONS Since urapidil decreased the high blood pressure in patients with pre-eclampsia without serious side-effects urapidil appears preferable superior to dihydralazine . The haemodynamic effects of urapidil were more predictable than those of dihydralazine . The reduction of intracerebral pressure could be an additional advantage of urapidil in the treatment of patients with pre-eclampsia The objective of the present study was to investigate whether increased beta-human chorionic gonadotrophin ( beta HCG ) plasma concentrations in an unselected population of nulliparas could predict the occurrence of complicated pregnancy-induced hypertension ( PIH ) . The design was that of a prospect i ve population study . It was conducted at the obstetric departments of Amiens University Hospital and Creil General Hospital on 434 consecutive nulliparas with singleton pregnancies after natural fertilization who accepted the systematic offer of trisomy 21 screening but for whom this disorder was finally estimated .  Measurement  of  plasma concentration of beta HCG ( ELISA method ) was carried out between 14 and 20 weeks ( mean : 17 weeks ) of amenorrhea , and measurement of blood pressure and proteinuria ( > 300 mg/24 h or Albustix + 2 ) during the first , second and third term and 2 - 3 months after the delivery , as well as measurement of birth weight for determination of  small for gestational age ( SGA ) babies , 37 women developed PIH , 10 without other complication , 16 with proteinuria ( 5 of which with SGA babies ) and 11 with SGA babies . Furthermore 2 patients presented abruptio placentae without PIH .  395 women did not develop PIH including 389 normotensive women and 6 chronic hypertensive patients without superimposed toxemia . Only 1 was diabetic . None had chronic renal disease .  Mean ( + /- SD ) levels of beta HCG were higher in PIH than in controls : 46,805 + /- 19,068 versus 23,479 + /- 13,463 IU . A pathologic threshold was chosen as the mean for the whole population + 1 SD : 25,613 + 15,479 = 41,082 IU . Elevated levels ( above this value ) were significantly associated with isolated PIH or PIH complicated with proteinuria and /or with SGA babies . The positive predictive value of this criterion was respectively 11 , 15 and 12 % for each of these complications . The relative risk ( and 95 % confidence limit ) of women with elevated beta HCG for each of these complications was 20 ( 6 - 79 ) , 11 ( 4 - 43 ) and 22 ( 7 - 93 ) . Elevated plasma beta HCG found around 17 weeks of amenorrhea predicts PIH complicated with either proteinuria or SGA babies with a positive predictive value comparable to that of the best and earliest test proposed up to now to select nulliparas at high risk of preeclampsia , namely the abnormalities of the Doppler waveforms of the uterine arteries . Since this test is simpler to perform , it represents the most convenient method to screen a population of nulliparas for evaluation of the benefits of low-dose aspirin Summary . Two treatment strategies were compared in 155 women with pregnancy‐induced hypertension who were also given comprehensive non‐pharmacological care . The mean gestation at entry was 28 weeks . As long as the diastolic blood pressure ( DBP ) remained below 106 mmHg , oxprenolol , or oxprenolol plus dihydralazine , were given to the early treatment group , and matching placebos to the control group . Open antihypertensive treatment was provided for patients whose DBP rose above 105 mmHg . Proteinuria occurred in seven women in each group . In the early treatment group , 13 of the 78 women were delivered by caesarean section ; the corresponding numbers in the control group were 27 of 76 ( 17 vs 36 % , 95 % confidence interval ( CI ) of difference : 5‐33 % ) ; the sections included seven and 16 in the early treatment and control groups , respectively , for severe hypertension and /or fetal distress . There were five perinatal deaths , two in the early treatment group and three in the control group . Early treatment did not influence gestational age at birth or birthweight . Respiratory distress syndrome occurred in four infants in the early treated group and in 10 in the control group ; 14 infants in the former group and 26 in the latter were in hospital for more than 10 days ( 18 vs 35 % ; 95 % CI of difference 4.32 % ) . These results indicate that early antihypertensive treatment with oxprenolol  is safe for the fetus and newborn in pregnancy‐induced hypertension , but has no advantage over non‐pharmacological care in terms of fetal growth . However , it may prevent acute hypertension in late pregnancy and associated fetal distress , and thus reduce the number of caesarean sections
Hydralazine was the most common drug for others to be evaluated against .
Diazoxide , given as 75 mg 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 .
Exceptions are diazoxide and ketanserin , which are probably not good choices
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 .