INTRAVENOUS HYDRALLAZINE OR INTRAVENOUS LABETALOL IN THE MANAGEMENT OF SEVERE HYPERTENSION AMONGST PREGNANT WOMEN IN PORT HARCOURT, NIGERIA: A RANDOMIZED CLINICAL TRIAL

Abstract

BACKGROUND: Hypertensive disorder of pregnancy is one of the direct causes of maternal mortality and morbidity globally. It is the leading cause of maternal mortality and morbidity in University of Port Harcourt Teaching Hospital (UPTH). Hydralazine, Labetalol and Nifedipine are generally regarded as first line drugs to lower blood pressure. Here at the UPTH, hydralazine was used but in recent times, labetalol has been introduced. Both drugs are now being used without a clear evidence of which is more effective. Thus, a large number of parturient might benefit if the drug that is found to be more effective is used extensively.
OBJECTIVE: The objective of this study was to compare the efficacy of intravenous labetalol and hydralazine in lowering severe hypertension in pregnancy. The specific objectives were to determine the time it took each antihypertensive agent to reduce blood pressure, the number of doses of each drug required, the adverse maternal effects and the perinatal outcome.
STUDY DESIGN: This was a randomized clinical trial; conducted in the labour ward of the University of Port Harcourt Teaching Hospital where pregnant women with hypertensive crisis were admitted for stabilization before delivery. Sixty (60) Pregnant women with sustained increase in systolic blood pressure of 160mmHg or higher or a diastolic blood pressure of 110mmHg or higher were randomized into 2 groups: GROUP A (30 pregnant women) received intravenous hydralazine 10mg slowly and repeated every 20 minutes until systolic blood pressure was 150mmHg and/or diastolic blood pressure was less or equal to 100mmHg. GROUP B (30 pregnant women) received intravenous labetalol in escalating doses of 20, 40, 80 and 80mg every 20 minutes until systolic blood pressure was 150mmHg and/or diastolic blood pressure was less than or equal to 100mmHg. RESULTS: Intravenous hydralazine required 28.00 ±3.65 minutes while intravenous labetalol required 75.27 ± 21.66 minutes to achieve the target blood pressure [p=0.00] . The number of doses required to achieve the target blood pressure was 1.33+/-0.547 for hydralazine and 3.0± 1.576 for labetalol [p=0.001] . Blood pressure control was achieved in 26 out of 30 (86.67%) women randomized to intravenous hydralazine when compared with 18 out of the 30 (60%) women randomized to labetalol. There were no severe perinatal morbidity or adverse maternal effects in the two groups. CONCLUSION: This study therefore concluded that intravenous hydralazine acts faster than intravenous labetalol in reducing blood pressure in pregnant women with severe hypertension in our population. Hydralazine is hereby suggested as a drug of first choice in severe hypertension in pregnancy in our population.

INTRAVENOUS HYDRALLAZINE OR INTRAVENOUS LABETALOL IN THE MANAGEMENT OF SEVERE HYPERTENSION AMONGST PREGNANT WOMEN IN PORT HARCOURT, NIGERIA: A RANDOMIZED CLINICAL TRIAL