The burden of hypertensive disorders during pregnancy and its associated maternal morbidity and mortality is rationale of this study. In our country antenatal care services are far from satisfactory hence incidence of severe hypertension during pregnancy and its morbid complications is very high. Every day our tertiary health care hospitals are receiving complicated cases of severe hypertension during pregnancy with high rate of maternal mortality. Recognition of severe blood pressure and its control is central for preventing intra cerebral haemorrhage that is most commonly attributed cause of maternal death worldwide. Many emergency antihypertensive drugs are being used worldwide under different RCTs with variable results so there is an uncertainty about the agent of first choice. In recent Cochrane database review no anti-hypertensive drug has been proven better than other. There is paucity of prospective studies on the subject in our country therefore, to know the effectiveness and fetomaternal safety profile of Hydralazine in our setup, we decided to compare it with Nifedipine that is freely available and commonly used antihypertensive agent.
To compare efficacy & safety of Hydralazine and Nifedipine in management of severe hypertension in pregnancy.
Randomized control trial
MCH (Unit II). PIMS, Islamabad.
Six month 1-1-2007 to 1-7-2007
METHODOLOGY. 60 cases meeting inclusion and exclusion criteria were recruited in high dependency area of labour ward. Inclusion criteria was pregnancy more than 28 weeks gestation and severe hypertension( BP > 160/110 mmHg) .Inform consent was taken after explaining the procedure and pros and cons of study. The registered subjects were randomly allocated to hydralazine group and Nifedipine group by using random number table. Blood pressure was checked in supine position on right arm with standard mercury sphygmomanometer before initiating treatment and thereafter checked at ½ hour, 1 hour, 1½ hour and 2 hours
Total 60 patients were recruited for this study. The mean initial Blood pressure was 170/113 mmHg. Time for effective control of systolic BP was 1 hour in Nifedipine group and 1 ½ in hydralazine group. Time taken for control of diastolic BP is same in both groups i.e. 1 hour. The mean prolongation of pregnancy was 4.5 days in Nifedipine group and 2 days in hydralazine group with a significant difference of p value .02. Fewer doses were required in Nifedipine group. Hydralazine was more associated with palpitation 56%, flushing 56%, persistent HTN 16.7% and tachycardia > 110 bpm 20%. There was no significant difference in other variables measuring fetomaternal outcome except that Nifedipine caused headache in 73% patients after drug administration.
CONCLUSION: Nifedipine is more effective for control of severe HTN.
KEY WORDS: Severe Hypertension, Preeclampsia, Hydralazine, Nifedipine
severe Hypertension , Preeclampsia, Nifedipine, hydralazine, pregnancy induced hypertension, labetalol