Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Nita K. Patel, Mansi Gadhavi, Dhaval Gorasia, Manish R. Pandya


Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension.

Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period.

Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h.

Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure.


Antihypertensive, Pregnancy-induced hypertension (PIH), Pre-eclampsia, Nifedipine, Methyldopa, Labetalol

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Lenfant C. National Education Program Working Group on High Blood Pressure in Pregnancy. Working group report on high blood pressure in pregnancy. J Clin Hypertens (Greenwich) 2001;3:75-88.

Sibai BM. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol 1990;163:1049-54.

Leather HM, Humphreys DM, Baker P, Chadd MA. A controlled trial of hypotensive agents in hypertension in pregnancy. Lancet 1968;2:488-90.

ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002;77:67-75.

Magee LA, Ornstein MP, Von Dadelszen P. Management of hypertension in pregnancy. Br Med J 1999;318:1332-6.

Plouin PF, Breart G, Llado J. A randomized comparison of early with conservative use of antihypertensive drugs in the management of pregnancy-induced hypertension. Br J Obstet Gynecol 1990;97:134-41.

Elhassan EM, Mirghani OA, Habour AB. Methyldopa versus no drug treatment in the management of mild preeclampsia. East Afr Med J 2002;79(4):172-5.

Magee LA, Elran E, Bull SB. Risks and benefits of beta receptor blockers for pregnancy hypertension: Overview of the randomized trials. Eur J Obstet Gynecol Reprod Biol 2000;88:15-26.

Pickles CJ, Broughton PF, Symonds EM. A randomized placebo controlled trial of labetalol in the treatment of mild to moderate pregnancy induced hypertension. Br J Obstet Gynaecol 1992;99:964-8.

Giannubilo SR, Bezzeccheri V, Cecchi S, Landi B, Battistoni GI, Vitali P, Cecchi L, Tranquilli AL. Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy. Arch Gynecol Obstet 2012;286:637-42.

El-Qarmalawi AM, Morsy AH, Al-Fadly A. Labetalol vs methyldopa in the treatment of pregnancy-induced hypertension. Int J Gynecol Obstet 1995;49:125-30.

Khedun SM, Moodley J, Naicker T. Drug management of hypertensive disorders of pregnancy. Pharmacol Ther 1997;74:221-58.

Mabie WC. Management of acute severe hypertension and encephalopathy. Clin Obstet Gynecol 1999;42:519-31.

Linton DM, Anthony J. Critical care management of severe pre-eclampsia. Intensive Care Med 1997;23:248-55.

Lamming GD, Broughton Pipkin F, Symonds EM. Comparison of the alpha and beta blocking drug, labetalol, and methyl dopa in the treatment of moderate and severe pregnancy-induced hypertension. Clin Exp Hypertens 1980;2:865-95.

Gallery ED, Saunders DM, Hunyor SN, Gyory AZ. Randomised comparison of methyldopa and oxprenolol for treatment of hypertension in pregnancy. Br Med J 1979;1(6178):1591-4.

Welt SI, Dorminy JH 3rd, Jelovsek FR, Crenshaw MC, Gall SA. The effects of prophylactic management and therapeutics on hypertensive disease in pregnancy: preliminary studies. Obstet Gynecol 1981;57:557-65.

Ounsted MK, Moar VA, Good FJ, Redman CW. Hypertension during pregnancy with and without specific treatment; the development of the children at the age of four years. Br J Obstet Gynaecol 1980;87:19-24.

Michael CA.The evaluation of labetalol in the treatment of hypertension complicating pregnancy. Br J Clin Pharmacol 1982;13(1 Suppl):127S-131S.