Doubt cast over use of hydralazine for hypertension in pregnancy
Research has cast doubt over the use of hydralazine as a first-line treatment for severe hypertension in pregnancy.
A meta-analysis of 21 trials found that hydralazine gave poorer maternal
and perinatal outcomes than some antihypertensives, and was less effective
than others. “The results of this review should generate uncertainty
about the agent of first choice for treating severe hypertension in pregnancy,” say
the Canadian researchers.
They found that hydralazine was associated with a trend towards less
persistent severe hypertension than labetalol but more severe hypertension
than nifedipine or isradipine. It also resulted in more maternal hypotension
than other antihypertensives, plus more caesarean sections and more placental
abruptions. More maternal side effects were seen with hydralazine than
with other antihypertensives.
“The results of this meta-analysis do not support recent recommendations
favouring initial use of hydralazine over other antihypertensives,” the
researchers comment. They suggest than nifedipine, labetalol or ketanserin
could all be considered as potential alternatives to hydralazine and
that more trials comparing these agents are needed (BMJ 2003;327:955). |
