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 .
Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia
BACKGROUND Pre-eclampsia is associated with extensive endothelial-cell damage and platelet activation , result ing in lower production of vasodilator prostagl and ins and increased release of the vasoconstrictors thromboxane A2 and serotonin . Damage to endothelial-cell serotonin-1 receptors leaves vasoconstriction and platelet aggregation mediated by serotonin-2 receptors unopposed . We investigated the role of ketanserin , a selective serotonin-2-receptor antagonist , in lowering the rate of pre-eclampsia among pregnant women with mild to moderate hypertension . METHODS We recruited 138 pregnant women into a double-blind , r and omised , placebo-controlled trial . They had diastolic blood pressure persistently more than 80 mm Hg before 20 weeks ' gestation . 69 women received ketanserin  and 69 received placebo . Both groups also received aspirin . Patients were initially given two tablets daily , increased to four tablets daily in diastolic blood pressure was more than 90 mm Hg . Primary outcomes were the development of pre-eclampsia and severe hypertension , and perinatal mortality . FINDINGS There were significantly fewer cases of pre-eclampsia ( two vs 13 ; relative risk 0.15 [ 95 % CI 0.04 - 0.66 ] , p = 0.006 ) and severe hypertension ( six vs 17 ; p = 0.02 ) in the ketanserin than in the placebo group . There was also a trend towards less perinatal mortality ( one vs six deaths ) but this was not significant ( p = 0.28 ) . Rates of abruptio placentae and pre-eclampsia before 34 weeks ' gestation were lower in the ketanserin group , and mean birthweight was significantly higher . INTERPRETATION We found an association between the addition of ketanserin to aspirin and a decrease in the number of cases of pre-eclampsia and severe hypertension , as well as improved pregnancy outcome among patients with mild to moderate midtrimester 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 .