A PROSPECTIVE CONTROLLED TRIAL OF METOPROLOL‐HYDRALAZINE TREATMENT IN HYPERTENSION DURING PREGNANCY l-Arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications Patient Acceptance of Guanethidine as Therapy for Mild to Moderate Hypertension: A Comparison with Reserpine [Atenolol and bisoprolol in the treatment of mild and moderately severe hypertension]. Appropriate Blood Pressure Control in NIDDM (ABCD) Trial Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial. Early blood pressure control improves pregnancy outcome in primigravid women with mild hypertension. A CONTROLLED STUDY OF THE EFFECTS OF AEROBIC EXERCISE ON ANTIHYPERTENSIVE DRUG REQUIREMENTS OF ESSENTIAL HYPERTENSIVE PATIENTS IN THE GENERAL PRACTICE SETTING Proteinuria in mild to moderate hypertension: results of the VA cooperative study of six antihypertensive agents and placebo. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. [Chronic high blood pressure in 110 pregnant women]. The ABCD (Appropriate Blood Pressure Control in Diabetes) trial. Rationale and design of a trial of hypertension control (moderate or intensive) in type II diabetes. Ketanserin versus dihydralazine for the treatment of severe hypertension in early-onset preeclampsia: a double blind randomized controlled trial. Diltiazem for treatment of essential hypertension: a double-blind controlled study with reserpine. Placebo‐controlled comparison of the efficacy and tolerability of once‐daily moxonidine and enalapril in mild‐to‐moderate essential hypertension Placebo-controlled comparison of the efficacy and tolerability of once-daily moxonidine and enalapril in mild-to-moderate essential hypertension. At equipotent doses, isradipine is better tolerated than amlodipine in patients with mild-to-moderate hypertension: a double-blind, randomized, parallel-group study. A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. A randomized double-blind clinical trial of xipamid and hydrochlorothiazide in essential hypertension. Effect of various antihypertensive drugs on plasma fibrinogen levels in patients with essential hypertension. Combined Versus Single Effect of Fosinopril and Hydrochlorothiazide in Hypertensive Patients Effect of single-drug therapy on reduction of left ventricular mass in mild to moderate hypertension: comparison of six antihypertensive agents. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. A randomized comparison of early with conservative use of antihypertensive drugs in the management of pregnancy‐induced hypertension A randomised comparison of hydralazine and mini-bolus diazoxide for hypertensive emergencies in pregnancy: the PIVOT trial.
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 . 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 The relative benefits and risks of reserpine and guanethidine were compared in patients with thiazide-treated mild to moderate hypertension ( diastolic pressure 95–115 mm Hg ) . Fortynine ambulant patients ( 30 men , 19 women ) were treated throughout the study with hydrochlorothiazide , 50 mg/day . In this double blind crossover study each drug was added in grade d increments until a predetermined therapeutic response was obtained , blood pressure measurements and side effect scores were evaluated biweekly . Major conclusions of the study were : 1 ) guanethidine , as well as reserpine , will reduce mild to moderate blood pressures to normal ; 2 ) in most cases , side effects which did occur while taking guanethidine or reserpine were well tolerated and neither drug was clearly superior . Side effects associated with larger doses of guanethidine employed in severe hypertension were absent or only slightly bothersome . Thus , guanethidine appears to have a good benefit-to-risk ratio in the therapy of mild to moderate hypertension and offers a number of advantages over drugs commonly used in this syndrome . This study refutes the common belief that guanethidine must be reserved only for the treatment of more severe degrees of hypertension Atenolol and bisoprolol , two beta-1-selective blockers , were compared in patients with mild and medium severe hypertension . Forty patients with a diastolic blood pressure of 95 - 115 mm Hg were two weeks after discontinuation of treatment divided at r and om into two groups treated with 50 mg atenolol and 5 mg bisoprolol . If the blood pressure was not affected by this dosage , the dose was raised to 100 mg atenolol and 10 mg bisoprolol . The blood pressure readings , heart rate , side effects of the drugs , laboratory and echocardiographic values were followed up for a period of three months . The authors recorded a marked decline of pressure and heart rate after the first week of therapy , the pressure readings in an upright position did not differ statistically from values in a sitting position , orthostatic hypotension was not recorded . The rate of success of bisoprolol was 85 % , of atenolol 75 % . During treatment no serious side-effects were observed . The biochemical parameters and echocardiographic values were not altered significantly by treatment . Atenolol and bisoprolol are two effective beta-1-selective blockers with a comparable effect in the treatment of mild and medium severe hypertension . They are useful in monotherapy as well as in combination with other antihypertensive drugs . In hypertension associated with diabetes mellitus , incipient bronchopulmonary disease and pregnancy they are also indicated . They are well tolerated also by elderly patients , an advantage of bisoprolol may be that it has a smaller impact on pressure and heart rate during the night Summary The ABCD ( Appropriate Blood Pressure Control in Diabetes ) Trial is a large , prospect i ve , r and omized clinical trial of 950 patients with non-insulin-dependent diabetes mellitus ( NIDDM ) design ed to compare the effects of intensive blood pressure control with moderate control on the prevention and progression of diabetic nephropathy , retinopathy , cardiovascular disease , and neuropathy in NIDDM . The secondary objective is to determine equivalency of the effects of a calcium channel blocker ( nisoldipine ) and an angiotensin-converting-enzyme inhibitor ( enalapril ) as a first-line antihypertensive agent in the prevention and /or progression of these diabetic vascular complications . The study consists of two study population s aged 40–74 years , 470 hypertensive patients ( diastolic blood pressure of ≥ 90.0 mmHg at time of r and omization ) and 480 normotensive patients ( diastolic blood pressure of 80.0 mmHg at time of r and omization ) . The study duration is 5 years and is scheduled to end in May of 1998 . Patients are r and omized to receive either intensive antihypertensive drug therapy or moderate antihypertensive drug therapy . Patients are also r and omized to nisoldipine or enalapril , with open-label medications added if further blood pressure control is necessary . The primary outcome measure is glomerular filtration rate as assessed by 24-h creatinine clearance . Secondary outcome measures are urinary albumin excretion , left ventricular hypertrophy , retinopathy , and neuropathy . Cardiovascular morbidity and mortality will also be evaluated . Given the data showing the impact of hypertension on complications in NIDDM , the ABCD Trial is design ed to determine if intensive antihypertensive therapy will be more efficacious than moderate antihypertensive therapy on the outcome of diabetic complications in NIDDM . [ Diabetologia ( 1996 ) 39 : 1646–1654 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 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 1 . To investigate the effect of an exercise training programme on antihypertensive drug requirements , 19 sedentary subjects ( 14 men and five women ) with mild essential hypertension ( systolic blood pressure greater than 140 mmHg but less than 180 mmHg ) , aged 29–55 years , were r and omly assigned to 16 weeks of moderate intensity exercise or light intensity exercise ( control ) , and titrated on antihypertensive drug therapy ( captopril and hydrochlorothiazide ) until  resting systolic blood pressure  ( sitting ) of less than 140 mmHg was achieved The prevalence and natural history of severe proteinuria in mild to moderate hypertension are not completely defined . We screened 1635 men with a history of hypertension and r and omized 1292 with untreated diastolic blood pressure ( DBP ) 95 - 109 mmHg to single-drug treatment with either hydrochlorothiazide , atenolol , captopril , clonidine , diltiazem-SR , prazosin , or placebo in a double-blind prospect i ve trial . Twenty-seven of 1635 patients ( 1.7 % ) satisfying clinical criteria for primary hypertension were found to have developed proteinuria > 1000 mg/24 hours and were removed from the study . Follow-up data were obtained on 19 of these 27 patients . One patient was found to have focal segmental sclerosis and progressed to end-stage renal disease . Three other patients developed severe ( serum creatinine > 3.5 mg/dl ) chronic renal failure ( one with diabetic nephropathy ) , one progressed from serum creatinine 1.4 to 2.2 mg/dl , but 14 of the 19 remained with stable serum creatinine < 2.0 mg/dl on follow-up for 6 - 9 years . Data were available for 1076 of 1155 ( 93 % ) treated study patients at end titration , 522/600 ( 87 % ) at one year and 322/444 ( 73 % ) at two years . There were significant associations for proteinuria with obesity and higher systolic blood pressure . There was a trend toward significant difference in mean 24-hour protein excretion rates at baseline between black ( 127 mg ) and white ( 139 mg ) patients ( p = 0.07 ) . There were no statistically significant changes in urinary protein excretion/24 hours between or within the different treatment groups ( including placebo ) . Eighteen patients were removed from the study during the active treatment phase for proteinuria > 1000 mg/24 hours : hydrochlorothiazide 4 , placebo 3 , diltiazem 3 , prazosin 3 , atenolol 2 , clonidine 2 , and captopril 1 . We conclude : ( 1 ) the prevalence of severe ( > 1 g/24 hours ) proteinuria in the hypertensive population is significant but does not necessarily imply a poor prognosis ; ( 2 ) mean 24-hour urinary protein excretion rates did not vary in response to the different classes of antihypertensive drugs ; and ( 3 ) there was no drug-specific increase in proteinuria detected in this study 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 The primary objective of the ABCD ( Appropriate Blood Pressure Control in Diabetes ) Trial is to determine the efficacy of intensive versus moderate antihypertensive control on the outcome of type II diabetic end-organ complications in normotensive and hypertensive population s. The secondary objective is to determine whether any differential effect on end-organ complications exists between an angiotensin converting enzyme inhibitor ( enalapril ) and a calcium channel blocker ( nisoldipine ) . DESIGN The ABCD Trial is a prospect i ve , controlled , r and omized , double-blind trial , with a planned follow-up of 5 years . SETTING All patients are seen at the Colorado Prevention Center , site of the ABCD Trial , for follow-up visits . PATIENTS Patients are type II diabetic males and females between the ages of 40 and 74 years with entry diastolic blood pressures > or = 80 mmHg . Patients were recruited from University of Colorado-affiliated hospitals , several health maintenance organizations , and mailing lists from the Colorado affiliate of the American Diabetes Association . INTERVENTIONS Patients were r and omized to intensive antihypertensive drug therapy or moderate antihypertensive drug therapy . Patients were also r and omized to nisoldipine or enalapril , with open-label medications added if further blood pressure control was necessary . MAIN OUTCOME MEASURES The primary outcome measure is glomerular filtration rate as assessed by 24-hour creatinine clearance . Secondary outcome measures are microalbumin urinary excretion , left ventricular hypertrophy , retinopathy , and neuropathy . Cardiovascular morbidity and mortality will also be evaluated . CONCLUSION Given the data showing the impact of hypertension on diabetic complications , the ABCD Trial was design ed to determine if intensive antihypertensive therapy will be more efficacious than moderate antihypertensive therapy on the outcome of these complications . Results from the ABCD Trial are expected to lend interpretable and clinical ly relevant findings with regards to the treatment of hypertension in type II diabetes 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 In a double-blind , parallel , 12-week trial , antihypertensive effects of diltiazem and reserpine were compared in 107 patients with essential hypertension .  Diltiazem reduced blood pressure from 176/100 mmHg to 154/86 mmHg after 12 weeks , and reserpine reduced blood pressure from 171/96 mmHg to 155/85 mmHg . The difference between diltiazem and reserpine was not statistically significant . However , among a subset of patients given 180 mg/day of diltiazem , a significantly better antihypertensive effect was achieved than among a subset given 0.3 mg of reserpine . The incidence of side effects and complications in the diltiazem group was about one half that in the reserpine group ( 12.3 % and 27.1 % , respectively ) . Side effects of diltiazem were mild , and the drug was extremely well tolerated . These results show that diltiazem is an effective antihypertensive drug for the treatment of mild to moderate essential hypertension Objectives To compare the antihypertensive efficacy and tolerability of the imidazoline I1 receptor agonist moxonidine , a central ly acting antihypertensive , with the angiotensin converting enzyme inhibitor enalapril . Design An 8-week , double-blind , r and omized , placebo- controlled study involving 140 out patients with mild-to- moderate essential hypertension . Methods Out patients with WHO stage I or II hypertension were enrolled in the study . After a 4-week placebo-controlled stabilization phase patients were allocated r and omly to placebo , 0.2 mg moxonidine once a day or 5 mg enalapril once a day for 2 weeks . Dosages were then doubled to 0.4 mg moxonidine once a day or 10 mg enalapril once a day for a further 6 weeks . Blood pressure responses to therapy were measured by conventional office techniques and by 24 h ambulatory blood pressure monitoring . Results The mean reduction in sitting blood pressure  with moxonidine was similar to that with enalapril ( 19.5 ± 16.0/12.3 ± 8.7 versus 18.9 ± 13.7/11.8 ± 8.0 mmHg ) and significantly superior to that with placebo ( -4.6 ± 12.3/-4.7 ± 6.8 mmHg , P < 0.001 ) . In addition to reducing blood pressure during conventional measurements , moxonidine administration reduced blood pressure throughout 24 h ambulatory measurements . The trough : peak ratio for moxonidine was 0.7 . Both moxonidine and enalapril were tolerated well . Conclusions Moxonidine is an effective and well- tolerated antihypertensive , at least as good as other established forms of antihypertensive medication . The trough : peak ratio of 0.7 indicates that the drug will be effective administered once a day OBJECTIVES To compare the antihypertensive efficacy and tolerability of the imidazoline I1 receptor agonist moxonidine , a central ly acting antihypertensive , with the angiotensin converting enzyme inhibitor enalapril . DESIGN An 8-week , double-blind , r and omized , placebo-controlled study involving 140 out patients with mild-to-moderate essential hypertension . METHODS Out patients with WHO stage I or II hypertension were enrolled in the study . After a 4-week placebo-controlled stabilization phase patients were allocated r and omly to placebo , 0.2 mg moxonidine once a day or 5 mg enalapril once a day for 2 weeks . Dosages were then doubled to 0.4 mg moxonidine once a day or 10 mg enalapril once a day for a further 6 weeks . Blood pressure responses to therapy were measured by conventional office techniques and by 24 h ambulatory blood pressure monitoring . RESULTS The mean reduction in sitting blood pressure with moxonidine was similar to that with enalapril ( 19.5 + /- 16.0/12.3 + /- 8.7 versus 18.9 + /- 13.7/11.8 + /- 8.0 mmHg ) and significantly superior to that with placebo ( -4.6 + /- 12.3/-4.7 + /- 6.8 mmHg , P < 0.001 ) . In addition to reducing blood pressure during conventional measurements , moxonidine administration reduced blood pressure throughout 24 h ambulatory measurements . The trough : peak ratio for moxonidine was 0.7 . Both moxonidine and enalapril were tolerated well . CONCLUSIONS Moxonidine is an effective and well-tolerated antihypertensive , at least as good as other established forms of antihypertensive medication . The trough : peak ratio of 0.7 indicates that the drug will be effective administered once a day 1 . The objective of this double-blind parallel-group study was to compare the tolerability of isradipine and amlodipine , specifically , the side-effects known to be related to the use of dihydropyridine calcium antagonists . 2 . A total of 205 patients with mild-to-moderate essential hypertension were r and omized to receive either the sustained-release ( SRO ) formulation of isradipine ( n = 103 ) or amlodipine ( n = 102 ) , both at dosages of 5 mg once daily . Blood pressure measurements were taken at the end of the dosing interval to assess the antihypertensive efficacy of the two drugs . 3 . Adverse reactions were assessed in two ways : a ) spontaneously reported adverse events were recorded and investigated in depth for severity , duration , relation to the study drug , and outcome ; b ) a question naire was used to elicit specific adverse reactions known to be related to the use of dihydropyridine calcium antagonists which were evaluated for severity , duration , relation to the study drug , and outcome . 4 . After 6 weeks of active treatment , both isradipine and amlodipine reduced mean sitting systolic/diastolic blood pressure : from 165.1/100.1 to 145.2/89.7 mm Hg with isradipine ; and from 164.1/100.6 to 145.7/90.5 mm Hg with amlodipine . There was no difference in antihypertensive effect between isradipine and amlodipine ( 95 % CI : -3.73 to 4.73 and -1.89 to 3.49 for differences in systolic and diastolic blood pressure , respectively ) . 5 . The number of patients spontaneously reporting adverse events was significantly higher ( P = 0.02 ; 95 % CI : 3.1 to 26.7 % ) with amlodipine ( 33.3 % ) than with isradipine ( 18.4 % ) . ( ABSTRACT TRUNCATED AT 250 WORDS 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 Seventeen patients with mild to moderate essential hypertension and controlled with antihypertensive drugs were treated with xipamid ( 40 mg ) or hydrochlorothiazide ( 50 mg ) in a double-blind cross-over r and omized trial design . After a run-in-period of 2 weeks with placebo , all of them received either of the two drugs . Placebo treatment for 2 weeks decreased both supine as well as st and ing blood pressure , but it was not statistically significant . Xipamid produced a somewhat greater decrease in blood pressure than hydrochlorothiazide , but the difference was not statistically significant . Similar results were obtained in 12 newly diagnosed cases of mild to moderate essential hypertension treated with xipamid ( 80 mg ) or hydrochlorothiazide ( 100 mg ) daily as single drug treatment in a r and omized , double-blind parallel design trial . The side effects produced by both drugs were only mild in nature . No significant changes were produced in serum electrolytes , uric acid and fasting blood glucose in this short term study with either of the drugs In recent years , substantial evidence has accumulated to unambiguously implicate high plasma fibrinogen levels as a major cardiovascular risk factor . An open prospect i ve and r and omised pilot study was therefore undertaken in mild to moderate hypertensives to evaluate the effect of various antihypertensive drugs viz enalapril , felodipine and prazosin on the blood pressure and plasma fibrinogen levels . The systolic and diastolic blood pressures were determined at 0 , 4 and 8 weeks whereas plasma fibrinogen assays were done at baseline and at the end of the 8th week of treatment in all the drug-treated groups . It was observed that although all the three drugs effectively controlled blood pressure , only enalapril significantly reduced plasma fibrinogen levels . Due to this additional effect , enalapril has potential to control two major cardiovascular risk factors -- hypertension and high plasma fibrinogen levels -- simultaneously The antihypertensive effect and safety of fosinopril and hydrochlorothiazide combined were compared with each drug singly and placebo in a controlled manner . After a 4- to 5-week placebo lead-in period , 67 mild to moderate essential hypertensive patients ( seated diastolic blood pressure £ 95 and £ 110 mm Hg ) were r and omized in a double-blind fashion into four parallel treatment groups : 20 mg fosinopril plus 12.5 mg hydrochlorothiazide , 20 mg fosinopril , 12.5 mg hydrochlorothiazide , and placebo during 8 weeks . Patients were seen biweekly . Sitting diastolic blood pressure was the outcome variable defining therapeutic response . The efficacy  of fosinopril plus hydrochlorothiazide as a combined therapy was superior to any single drug ( P<.05 ) and placebo ( P<.01 ) in the treatment of mild to moderate essential hypertension . Mean adjusted systolic/diastolic blood pressure decrements at week 8 were −18.8/−13.7 , −12.9/−11.8 , −8.5/−9.3 , and −2.11−6.9 mm Hg for the fosinopril plus hydrochlorothiazide , fosinopril , hydrochlorothiazide , and placebo groups , respectively . Clinical adverse events and laboratory changes documented throughout the study were similar to placebo and were mild in severity in all groups BACKGROUND Antihypertensive drugs may differ in their ability to reduce LV mass . Covariates other than drug selection , such as pretreatment LV mass , body weight , the magnitude of blood pressure reduction , race , and age may modify the response of LV mass to therapy . METHODS AND RESULTS Patients with mild to moderate hypertension ( diastolic blood pressure , 95 to 109 mm Hg ) were r and omly allocated to treatment with atenolol , captopril , clonidine , diltiazem , hydrochlorothiazide , or prazosin in a double-masked trial . Patients achieving the goal diastolic blood pressure of < 90 mm Hg during drug titration entered a 1-year maintenance period . Longitudinal analysis examined changes from baseline echocardiogram in LV mass at 8 weeks and at 1 year , statistically adjusted for pretreatment LV mass , systolic blood pressure , body weight , sodium excretion , physical activity , race , and age . Significant reductions at 1 year in adjusted LV mass were seen for patients in the highest tertile of pretreatment LV mass treated with hydrochlorothiazide ( mean , -42.9 ; 95 % confidence limits , -65.5 , -20.2 g ) , captopril ( mean , -38.7 ; 95 % confidence limits , -61.0 , -16.4 g ) , and atenolol ( mean , -28.1 ; 95 % confidence limits , -50.9 , -5.3 g ) . These treatment effects differed from those of prazosin , diltiazem , or clonidine . CONCLUSIONS Antihypertensive drugs have disparate effects on LV mass independent of the magnitude of blood pressure reduction . Patients with adequate blood pressure control on captopril , hydrochlorothiazide , and atenolol show a reduction of LV mass after 1 year of treatment , whereas patients on diltiazem , clonidine , or prazosin do not 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 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
REVIEW ER 'S CONCLUSIONS It remains unclear whether antihypertensive drug therapy for mild-moderate hypertension during pregnancy is worthwhile
BACKGROUND Mild-moderate hypertension during pregnancy is common .
Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease , and thereby improve outcome .
OBJECTIVES To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy .