Key result
In pregnant women with chronic hypertension, there was a modest difference between the effects of labetalol and nifedipine MR on systolic and diastolic blood pressure time-series (p=0.014).
Why the study?
Does nifedipine MR improve blood pressure control and reduce variability compared to labetalol in pregnant women with chronic hypertension?
Observational (n=48)
No
Does nifedipine MR improve blood pressure control and reduce variability compared to labetalol in pregnant women with chronic hypertension?
p-value: p=0.014
Nifedipine MR provides more stable daytime blood pressure control with less variation compared to labetalol in pregnant women with chronic hypertension.
May support nifedipine MR for more stable BP control in pregnant chronic hypertension; leaves open confirmation in RCTs.
AIM: To compare the blood pressure (BP) lowering effects of labetalol and nifedipine modified release (MR) in hypertensive pregnant women. We also investigated the effect on the heart rate (HR) and determined the proportion of time spent in target. METHODS: This was an exploratory study. Women with chronic hypertension taking either labetalol or nifedipine were offered 24-h ambulatory blood pressure monitoring (ABPM). Sleep, wake and drug ingestion times were self-reported. An indirect response model was used to analyse the systolic BP (SBP), diastolic BP (DBP) and HR time-series; the effect of gestation and type of drug was evaluated. RESULTS: Forty-eight women were recruited: 24 in each group. There was no difference in clinical characteristics. In women taking nifedipine there was a positive association between the dose of nifedipine and pre-dose BP p = .002, this was not present in the labetalol group. There was a difference between the drug effects on both the SBP and DBP time-series (p = .014). In comparison to labetalol, there was less variation in day time BP in those women prescribed nifedipine. Women on labetalol spent a larger proportion of time with their DBP below target (<80 mmHg). The HR dynamics were qualitatively different, a stimulatory effect was found with nifedipine compared to an inhibitory effect with labetalol. CONCLUSION: There are significant and important differences between the BP lowering effects of nifedipine and labetalol. A large randomised control trial is required to investigate the relationship between BP variability and time in target on pregnancy outcomes.
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Shawkat et al. (2018) conducted an observational in Chronic hypertension in pregnancy (n=48). Labetalol vs. Nifedipine MR was evaluated on Systolic and diastolic blood pressure time-series (p=0.014). In pregnant women with chronic hypertension, there was a modest difference between the effects of labetalol and nifedipine MR on systolic and diastolic blood pressure time-series (p=0.014).
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