Résumé
Objetivo. Comparar la eficacia del labetalol oral con alfa-metildopa oral en el tratamiento de la hipertensión severa en preeclámpticas. Diseño. Estudio de casos y controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes. 200 preeclámpticas que fueron asignadas al azar para ser tratadas con labetalol oral (grupo A) o con alfa-metildopa oral (grupo B). Principales medidas de resultado. Eficacia del tratamiento de la hipertensión, tasa de persistencia de la hipertensión y efectos adversos relacionados con el uso de los fármacos. Resultados. No se encontraron diferencias entre los grupos con relación a edad materna, edad gestacional al momento de la inclusión en el estudio e índice de masa corporal (p = ns). Tampoco se observaron diferencias estadísticamente significativas en los valores de presión arterial sistólica, diastólica y media entre los grupos (p = ns). Se observó que las pacientes tratadas con labetalol oral presentaron valores significativamente más bajos de presión arterial sistólica, diastólica y media comparadas con las pacientes tratadas con alfa-metildopa oral (p < 0,0001). Ninguna paciente en el grupo A presentó persistencia de la hipertensión comparado con 17 pacientes en el grupo B (p < 0,0001). El síntoma más común en el grupo A fue la cefalea y en el grupo B, las náuseas, que mostraron ser significativamente más frecuentes (p = 0,006). Conclusión. El labetalol oral fue más efectivo que la alfa-metildopa en el tratamiento de la hipertensión severa en preeclámpticas.
Objective: To compare the efficacy of oral labetalol with oral alpha-methyldopa in the treatment of severe hypertension in preeclamptic patients. Design: Case-control study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participants: 200 preeclamptic patients who were randomly assigned to be treated with oral labetalol (group A) or with oral alpha-methyldopa (group B). Main outcome measures: Hypertension treatment efficacy, rate of persistence of hypertension and adverse effects related to drug use. Results: There were no differences between groups regarding maternal age, gestational age at the time of inclusion, and body mass index (p = ns). There were also no statistically significant differences in systolic, diastolic and mean arterial pressure between groups (p = ns). We observed that patients treated with oral labetalol had significantly lower values of systolic, diastolic and mean arterial pressure compared to patients treated with oral alphamethyldopa (p < 0.0001). No patient in group A had persistent hypertension, while 17 patients in group B did present it (p < 0.0001). The most common symptom in group A was headaches; in group B, nausea was significantly more frequent (p = 0.006). Conclusion: Oral labetalol is more effective than alpha-methyldopa in the treatment of severe hypertension in preeclamptic patients.
Résumé
Objetivo: Avaliar os efeitos do uso de alfametildopa em gestantes portadoras de Hipertensäo arterial leve ou moderada, bem como no concepto. Material e Métodos: Trinta e uma gestantes hipertensas, com idade média de 31 anos, sendo seis (10,35%) primigestas, submetidas, após a 12§ semana de gestaçäo, ao uso de alfametildopa, em dose inicial de 250 mg/dia, aumentada semanalmente de acordo com a resposta. Os níveis tensionais foram medidos em posiçöes supina e ereta e as pacientes submetidas a avaliaçäo laboratorial incluindo verificaçäo das taxas sangüíneas de hemoglobina, hematócrito, leucócitos, bilirrubina, fosfatase alcalina, ácido úrico, além de reaçäo de Coombs, clearance de creatinina, bem como ultrassosnografia obstétrica e eletrocardiograma. Foram analisadas as condiçöes de parto,d e evoluçäo puerperal, de nascimento e de desenvolvimento do concepto até os três anos de idade. Reultados: alfametildopa foi empregada em média por 14,2 semanas, em doses médias de 685 g/dia. Houve eficácia terapêutica no controle dos níveis tensionais em 30(96,77%) pacientes. Näo foram registrados efeitos colaterais de natureza clínica ou laboratorial. A droga näo se associaou a anormalidades no parto, no puerpério, no recém-nato e no desenvolvimento pôndero-estadual das crianças até período de três anos de idade. Conclusäo: A alfametildopa mostrou-se droga eficaz e bem tolerada no controle de Hipertensäo arterial leve ou moderada de gestantes, näo se associando a influências desfavoráveis no decorrer do ciclo gravídico-puerperal e no desenvolvimento da criança no periódo observado
Purpose: To evaluate the effects of alpha methyldopa in pregnant women with mild to moderate arterial hypertension as well as in the offsprings. Material and Methods: Thirty one pregnant hypertensive women, mean age 31 years, six (10.35%) primigravids, after the 12th week of pregnance received alpha methyldopa, initial 250mg/day, weekly increased depending to the response. Blood pressure was measured in supine and standing positions and the patients were submitted to a laboratorial evaluation including: hemoglobin, hematocrit, leukocytes, platelets, urea, creatinin, glucose, transaminases, bilirrubin, alkaline phosphatase, uric acid, Coombs, creatinin clearance, as well as obstetric ultrassonography and electrocardiogram. The labor, childbirth conditions and puerperal evolution, were evaluated as well as the development of the offspring up 3 years of age. Results: Alpha methyldopa was administred for an average period of 14.2 weeks, mean dose of 685 mg/day. In thirty patients (96.77%) blood pressure was efficiently controlled. Clinical and laboratorial adverse experiences were not observed. The use of drug was not associated with abnormalities during the labor, in the purperium, in the newborn and during the development of the children up 3 years of age. Conclusion: Alpha methyldopa is efficacious and well tolerated in the control of mild to moderate hypertension in pregnant women, and is not associated with unfavorable consequences during the pregnancy, puerperal cycle an in the development of the children in the study period.