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 .
Treatment of hypertension in patients with pre-eclampsia: a prospective parallel-group study comparing dihydralazine with urapidil.
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
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 .