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Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis

Background: Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review ai...

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Autores principales: Awaludin, Adila, Rahayu, Cherry, Daud, Nur Aizati Athirah, Zakiyah, Neily
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8872490/
https://www.ncbi.nlm.nih.gov/pubmed/35206939
http://dx.doi.org/10.3390/healthcare10020325
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author Awaludin, Adila
Rahayu, Cherry
Daud, Nur Aizati Athirah
Zakiyah, Neily
author_facet Awaludin, Adila
Rahayu, Cherry
Daud, Nur Aizati Athirah
Zakiyah, Neily
author_sort Awaludin, Adila
collection PubMed
description Background: Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review aimed to assess the efficacy and safety of antihypertensive drugs in severe hypertension during pregnancy. Methods: A systematic review using the electronic databases MEDLINE (PubMed) and Cochrane Library was performed until August 2021. The risk-of-bias 2 tool was used to assess the risk-of-bias in each study included. Meta-analysis was conducted to assess heterogeneity and to estimate the pooled effects size. Results: Seventeen studies fulfilled the inclusion criteria and 11 were included in the meta-analysis. Nifedipine was estimated to have a low risk in persistent hypertension compared to hydralazine (RR 0.40, 95% CI 0.23–0.71) and labetalol (RR 0.71, 95% CI 0.52–0.97). Dihydralazine was associated with a lower risk of persistent hypertension than ketanserin (RR 5.26, 95% CI 2.01–13.76). No difference was found in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between antihypertensive drugs, except for dihydralazine, which was associated with more adverse effects than ketanserin. Conclusions: Several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, oral methyldopa, IV hydralazine, IV dihydralazine, IV ketanserin, IV nicardipine, IV urapidil, and IV diazoxide. In addition, nifedipine may be preferred as the first-line agent. There was no difference in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between the drugs, except for adverse effects in IV dihydralazine and IV ketanserin.
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spelling pubmed-88724902022-02-25 Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis Awaludin, Adila Rahayu, Cherry Daud, Nur Aizati Athirah Zakiyah, Neily Healthcare (Basel) Review Background: Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review aimed to assess the efficacy and safety of antihypertensive drugs in severe hypertension during pregnancy. Methods: A systematic review using the electronic databases MEDLINE (PubMed) and Cochrane Library was performed until August 2021. The risk-of-bias 2 tool was used to assess the risk-of-bias in each study included. Meta-analysis was conducted to assess heterogeneity and to estimate the pooled effects size. Results: Seventeen studies fulfilled the inclusion criteria and 11 were included in the meta-analysis. Nifedipine was estimated to have a low risk in persistent hypertension compared to hydralazine (RR 0.40, 95% CI 0.23–0.71) and labetalol (RR 0.71, 95% CI 0.52–0.97). Dihydralazine was associated with a lower risk of persistent hypertension than ketanserin (RR 5.26, 95% CI 2.01–13.76). No difference was found in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between antihypertensive drugs, except for dihydralazine, which was associated with more adverse effects than ketanserin. Conclusions: Several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, oral methyldopa, IV hydralazine, IV dihydralazine, IV ketanserin, IV nicardipine, IV urapidil, and IV diazoxide. In addition, nifedipine may be preferred as the first-line agent. There was no difference in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between the drugs, except for adverse effects in IV dihydralazine and IV ketanserin. MDPI 2022-02-09 /pmc/articles/PMC8872490/ /pubmed/35206939 http://dx.doi.org/10.3390/healthcare10020325 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Awaludin, Adila
Rahayu, Cherry
Daud, Nur Aizati Athirah
Zakiyah, Neily
Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis
title Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis
title_full Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis
title_fullStr Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis
title_full_unstemmed Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis
title_short Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis
title_sort antihypertensive medications for severe hypertension in pregnancy: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8872490/
https://www.ncbi.nlm.nih.gov/pubmed/35206939
http://dx.doi.org/10.3390/healthcare10020325
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