RESUMO
Background: Hypertensive diseases are commonly seen during pregnancy and remain one of the leading causes of maternal morbidity and mortality. Mostly commonly preferred drugs by health care providers for treatment of severe hypertension during pregnancy are labetalol and hydralazine. However, they require proper storage, intravenous access, and adequately trained staff for usage. Oral nifedipine in contrast is easier to use and widely available. Objective of this study was to report the efficacy and safety of oral nifedipine as compared to intravenous labetalol for treatment of severe hypertension during pregnancy.Methods: It was an open label randomized controlled trial in which 100 women with severe hypertension during pregnancy were enrolled. They were randomized to receive either incremental doses of intravenous labetalol every 20 minutes (total 300 mg) or 10 mg oral nifedipine every 20 minutes (up to 50 mg) to lower the blood pressure to safer levels.Results: Women receiving oral nifedipine took significantly less time to achieve target blood pressure [(37.6±23.3) minutes (SD) as compared to those receiving intravenous labetalol (52.0 minutes±27.95 (SD)]. Women receiving nifedipine for treatment also required significantly lesser doses to control the blood pressure [mean dose 1.8±1.1 (SD) versus 2.6±1.2 (SD) p=0.006]. There were two failures in labetalol group and one failure in nifedipine group. No serious adverse events were reported in either group.Conclusions: Oral nifedipine is equally efficacious to I.V. labetalol for treatment of severe hypertension during pregnancy and is easier to use in low resource settings.
RESUMO
Background: To compare intravenous labetalol with oral nifedipine in terms of rapidity at which they control blood pressure in acute hypertensive emergencies of pregnancy.Methods: A randomized controlled study. Pregnant women with severe gestational hypertension with BP ≥160/110 mmHg after ≥20 weeks of gestation were randomized with computer generated numbers, either to receive IV labetalol with an escalating dose of 20, 40, 80, 80 and 80 mg or nifedipine capsule orally in a dose of 10 mg every 15 minutes (upto 5 doses) until a BP of ≤150/100 mmHg is achieved. Crossover treatment was to be effected if initial treatment regimen was unsuccessful. Primary outcome was time taken and number of doses required to achieve the target BP of ≤150/100 mmHg. Secondary outcomes were volume of urine output, maternal heart rate changes, fetal heart rate abnormality, perinatal and maternal outcome and side effects.Results: Oral nifedipine achieved the target BP (≤150/100 mmHg) more rapidly in (26.25±12.60) minutes in comparison to (32.62±12.19) minutes with IV labetalol (p= 0.024). Nifedipine group also took less number of doses to achieve the target BP of (≤150/100 mmHg) mmHg than IV labetalol (1.75±0.840 vs. 2.18±0.83), p= 0.024. Volume of urine output was also significantly more in nifedipine group (94.90±1.84 ml) at 1 hour and thereafter till 24 hour of treatment in comparison to IV labetalol (41.28±2.14 ml), p= 0.000. Side effects are few and not serious. No patient required crossover treatment.Conclusions: Both the drugs are equally effective in controlling acute hypertensive emergencies of pregnancy, however oral nifedipine is more rapid in controlling severe hypertension and also it is associated with significantly increased urine output.
RESUMO
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.
RESUMO
Facial paralysis was first described in a hypertensive patient by Moxon in 1869. Subsequently, there have been reports and facial palsy is mentioned as a rare feature of hypertension. Recently, we experienced a case of recurrent facial paralysis in a severe hypertensive child. A 13-month-old boy was admitted because of right peripheral facial paralysis. Two months ago, transarterial embolization of his left renal aneurysm with coils was performed due to left renal dysplasia and renal artery aneurysm. On admission, his blood pressure was 200/110 mmHg. He was treated conservatively with antihypertensive agents and his facial paralysis completely resolved during the next two months. One year later, he experienced facial paralysis again. He was admitted and treated with antihypertensive agents. And his paralysis resolved in the next two months. After his left nephrectomy, performed three years later, there was no additional episode of facial paralysis during the next seven years. We report this case with a brief review of literatures.