DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20163240

A prospective observational study to compare efficacy and safety of methyldopa and nifedipine in management of moderate gestation hypertension

Anand R. Kanaki, Nitin S. Kunnoor, Sharanabasappa .

Abstract


Background: Hypertensive disorder in pregnancy is one of the most common complications of pregnancy worldwide. It is associated with maternal mortality and morbidity as well as perinatal mortality. Antihypertensive drugs are often used to lower blood pressure with the aim of preventing its progression to adverse outcomes for the mother and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. Studies have been done using various antihypertensive in hypertensive disorders of pregnancy. But there are very few studied comparing nifedipine and methyldopa in hypertensive disorders of pregnancy where majority of the studies are evaluated for short duration. Hence we have undertaken this study to compare the efficacy and safety of methyldopa and nifedipine in patient with moderate gestational hypertension.

Methods: This is a prospective observational study where pregnant patients with moderate gestational hypertension either on oral nifedipine 10 mg t.i.d. or on methyl-dopa 250 mg t.i.d. were enrolled during 6 month period. Data at week one and week four were observed along with side effects. Reduction in systolic and diastolic blood pressure from baseline and occurrence of side effects were studied. The statistical significance was at P < 0.05.

Results: The mean reduction of systolic/diastolic BP with methyldopa in four weeks was 17/13 mmHg as compared to nifedipine being 18.5/14.5 in four week. There was significant reduction in systolic blood pressure in nifedipine group compared to methyldopa group at four weeks (p-0.04). Both treatments were well tolerated with minimal side effects.

Conclusions: Methyldopa and Nifedipine are equally effective in controlling blood pressure in moderate gestational hypertension with minimal side effects. However, nifedipine can be preferred over methyldopa as it showed significant reduction in systolic blood pressure at four weeks.


Keywords


Moderate gestational hypertension, Methyldopa, Nifedipine

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References


API India Medicine Update. Managing hypertension in pregnancy. 2012. Available at http://www.apiindia.org/pdf/medicine_update_2012/hypertension_08.pdf.

Datta D, Concessao LP. Management of Hypertension in Pregnancy. Journal of Pharmacy research. 2011;4(5):1340-2.

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-22.

Chauhan R, Sharma RS, Parashar MK, Chauhan VS. Clinical examination of hypertension in pregnancy. In: Shah MR, editor. Hypertensive disorders in pregnancy: 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. 2007:111-25.

Zibaeenazhad MJ, M Ghodsi P Arab, Gholzom N. The prevalence of hypertensive disorders of pregnancy in Shiraz, Southern Iran; Iranian Cardiovascular Research Journal. 2010;4:169-72.

Davey DA, Mac Gillivray I. The classification and definition of the hypertensive disorders of pregnancy. American Journal of Obstetrics and Gynecology. 1988;158:892-8.

Gifford RW, August P, Chesley LC, Cunningham G, Ferris TF, Lindheimer MD. National high blood pressure education program working group report on high blood pressure in pregnancy. American Journal of Obstetrics and Gynecology. 1990;163:1691-712.

North RA, Taylor RS, Schellenberg JC. Evaluation of the definition of pre-eclampsia. British Journal of Obstetrics and Gynaecology. 1999;106:767-73.

NICE Guidelines. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. 2010 (Revised 2011). Available online: www.nice.org.uk.

Lindheimer A, Umans JG. Explaining and predicting preeclampsia. New England Journal of Medicine. 2006;355:1056-58.

Saudan P, Brown MA, Buddle ML. Does gestational hypertension become pre-eclampisa? British Journal of Obstetrics and Gynecology. 1998;105:1177-84.

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

Rey E, LeLorier J, Burgess E, Lange IR, Leduc L. Report of the Canadian Hypertension Society Consensus Conference: 3.Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ. 1997;157(9):1245-54.

Redman CWG, Beilin LJ, Bonnar J. Treatment of hypertension in pregnancy with methyldopa: blood pressure control and side effects. British Journal of Obstetrics and Gynaecology. 1977;84:419-26.

Redman CWG. Drugs, hypertension and pregnancy. Prog Obstet Gynaecol. 1989:83-95.

Thomas M, Hoffman BB. Treatment of myocardial ischemia and Hypertension. In: Laurence L. Brunton, Brunce A. Chabner, Bjorn C. Knollmann, editors. Goodman and Gilman’s The pharmacological basis of therapeutics. 12th ed. Mcgraw Hill. 2011;27:773-74.

Hans SF, Kopelman H. Methyldopa in treatment of severe toxaemia of pregnancy. British Medical Journal. 1964;1:736-9.

Subhedar V, Inamdar S, Hariharan C, Subhedar S. Comparison of efficacy of labetalol and methyldopa in patients with pregnancy-induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. Int J Reprod Contracept Obstet Gynecol. 2013;2(1):27-34.

Sorkin EM, Clissold SP, Brogden RN. Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in ischaemic heart disease, hypertension and related cardiovascular disorders. 1985;30:182-274.

Ulmsten U, Anderssn KE, Forman A. Relaxing effects of nifedipine on the pregnant uterus in vitro and in vivo. Relaxing effects of nifedipine on the pregnant uterus in vitro and in vivo. 1978;52:536-41.

Sibai BM, Barton JR, Sherif AKL, Sarinoglu C, Mercer BM. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. 1992;167:879-84.

Bharathi KN, Prasad KVSRG, Jagannath P, Nalini KS. Comparison of Nifedipine with Methyldopa For Control Of Blood Pressure In Mild To Moderate Pregnancy Induced Hypertension. Journal of clinical and diagnostic research. 2010;4(3):2406-9.

Jayawardena J, Lekamge N. A comparison of nifedipine with methyldopa in pregnancy induced hypertension. Ceylon Med J. 1994;39(2):87-90.

Fairbanks LD, Escuredo E, Duley JA, Simmonds HA. S. Adv Exp Med Biol 2000;486:383-8.

Aparna J. A randomized, double-blind, comparative trial of nifedipine and methyldopa in moderate pregnancy induced hypertension. Der Pharmacia Lettre. 2013:5(4):274-7.

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