A study of oral Nifedipine and intravenous Labetalol in severe hypertension in pregnancy at teaching hospital

Background: Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. Aim: To compare intravenous Labetalol with oral Nifedipine in their rapidity to control hypertensive emergencies of pregnancy. Materials and methods: Pregnant woman with severe gestational hypertension ≥ 160/110 mm of Hg were randomized to receive intravenous Labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) or Nifedipine (10mg tab orally upto 5 doses ) until the target blood pressure of 150/90mm of Hg was achieved. Crossover treatment was effected if the initial treatment regimen was unsuccessful. Results: Mean time required 47 ± 14 mins in the Labetalol groups and 45 ± 15minutes in the Nifedipine group. This comparison showed no difference in the two groups with a ‘P' value of >0.05. The mean amount of drugs required to achieve BP 150/90mm of Hg were 96 ± 38in the Labetalol group and 23 ± 13mg in the Nifedipine group. And this comparison showed no difference statistically with a ‘P' value of >0.05. Most of the patients were controlled by 2 doses of each drug, 56% in the Labetalol group and 62% in the Nifedipine group. 12% and 14% in the Labetalol and Nifedipine group respectively were not controlled by 5 doses of either drug and required crossover drug therapy. Most of the patients were controlled by two doses of each drug, 50% in the Labetalol group and 60% in the Nifedipine group. 12.5% and 17.5% in the Labetalol & Nifedipine group respectively were not controlled by 5 doses of either drug andrequires crossover drug therapy. Conclusions: Labetalol is both effective and safe in severe HTN.ACOG recommends labetalol as an appropriate first line treatment in severe HTN in pregnancy.