Methyldopa plus amlodipine achieved target systolic blood pressure in 87% of pregnant women with gestational hypertension compared to 75% with methyldopa plus metoprolol (p=0.32).
RCT (n=60)
Randomly divided
Does methyldopa plus amlodipine improve blood pressure reduction compared to methyldopa plus metoprolol in pregnant women with gestational hypertension?
Both methyldopa+metoprolol and methyldopa+amlodipine effectively lower blood pressure in gestational hypertension, with amlodipine providing a greater degree of reduction but similar target achievement rates.
Absolute Event Rate: 87% vs 75%
p-value: p=0.32
Objective: To evaluate the effectiveness of combined antihypertensive drug therapy on blood pressure parameters in pregnant women with GHT. Design and method: Study included 60 pregnant women with GHT according to 2018 ESC Guidelines, randomly divided into 2 groups based on therapy: Group 1 (n=30) received methyldopa (500-1000 mg) + metoprolol (50 mg) and Group 2 (n=30) received methyldopa (500-1000 mg) + amlodipine (5 mg). Groups were comparable in terms of age (30±3,7 vs 32±5,3, p= 0.0955), parity (2,4±1,5 vs 3,1±1,9, p=0.1187), number of pregnancies (3,55±1,9 vs 4,1±1,8, p=0.2545), gestational age (29±2,4 vs 29±2,36, p=1.0000) and pretreatment SBP (150,8±8,3 vs 153,4±10,3, p=0.2861) and DBP (92,6±5,4 vs 94,16±7,62, p=0.3640). Dose titration and BP monitoring were carried out at 26-28, 30-32, 34-36 and 36-38 weeks of pregnancy. All patients underwent fetal Doppler ultrasonography, signed informed consent, office pressure was measured and ABPM was performed before and after prescription of AHT. Results: Analysis of office BP in both groups showed significant decrease in SBP, DBP and mean BP (p=0.0001). However, the degree of reduction (δ%) for SBP (p=0.0116) and DBP was statistically higher in Group II, especially for SBP and DBP (p=0.0123), which is probably explained by the vasodilatory effect of amlodipine. But this indicator for mean BP was not significant (p=0.3454), probably due to similar hemodynamic load of both regimens. Target SBP levels were achieved in 75% of patients in the first group and 87% of patients in the second group (χ2=0.98, p=0.32). Target DBP levels were achieved in 75% and 91% of patients, respectively (χ2=2.02, p=0.15), but no statistically significant difference was found between the groups.Conclusions: Both treatment regimens enabled the achievement of target blood pressure (BP) levels. It should be noted that although the number of patients in the second group who achieved target systolic (SBP) and diastolic (DBP) blood pressure was higher, this requires further study in a larger cohort of patients.
Садуллоева et al. (Fri,) conducted a rct in Gestational arterial hypertension (n=60). Methyldopa + amlodipine vs. Methyldopa 500-1000 mg + metoprolol 50 mg was evaluated on Achievement of target systolic blood pressure (p=0.32). Methyldopa plus amlodipine achieved target systolic blood pressure in 87% of pregnant women with gestational hypertension compared to 75% with methyldopa plus metoprolol (p=0.32).