Maternal ethnicity and its impact on the haemodynamic and blood pressure response to labetalol for the treatment of antenatal hypertension

OBJECTIVE: Blood pressure (BP) control outside pregnancy is associated with a reduction in adverse cardiovascular events, and in pregnancy with improved outcomes. Outside pregnancy, there is evidence β-blockers are less effective in controlling BP in black populations. However, in pregnancy, labetalol is recommended as a universal first-line treatment, without evidence for the impact of ethnicity on its efficacy. We sought to compare haemodynamic responses to labetalol in black and white pregnant patients. METHODS: This was a prospective observational cohort study in a London teaching hospital. Maternal haemodynamics were assessed in 120 pregnant women treated with labetalol monotherapy. Measurements were taken at presentation, 1 and 24 h after treatment. Participants were monitored regularly until delivery. Statistical analysis was performed by multilevel modelling. RESULTS: Both groups exhibited similar temporal trends in haemodynamic changes over the first 24 h following labetalol. Both showed a reduction in BP and peripheral vascular resistance within 1 h and in heart rate after 24 h. There was no change in cardiac output and stroke volume in either group. BP control (<140/90) was achieved at 1 h in 79.7% of the white and 77% of the black cohort. At 24 h, control was achieved among 83.1% and 63.9%, and up to the immediate intrapartum period control was achieved in 89.8% and 70.4% of white and black patients, respectively. CONCLUSIONS: There is no difference in the acute haemodynamic changes and hypertension can be controlled throughout pregnancy with labetalol monotherapy in excess of 70% pregnant black and white patients.