BJOG : an international journal of obstetrics and gynaecology · 2000
Nifedipine or prazosin as a second agent to control early severe hypertension in pregnancy: a randomised controlled trial.
Клиническое исследованиеСтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Hall D R, Odendaal H J, Steyn D W, Smith M
Аннотация
OBJECTIVE: To determine whether nifedipine or prazosin is the more appropriate second-line antihypertensive agent in pregnancy.
DESIGN: Randomised controlled trial.
SETTING: Tygerberg Hospital, a tertiary referral centre.
POPULATION: Women with early, severe pre-eclampsia or hypertension in pregnancy, whose blood pressure could not be adequately controlled by methyldopa 2 g/day, but were otherwise stable.
METHODS: Nifedipine or prazosin were given and increased as necessary in a stepwise fashion. Once the maximum dose was reached, the other drug was added in a crossover pattern. Failure to control blood pressure, or the onset of maternal/fetal complications were indications for delivery. Patients reaching a minimum gestation of 34 weeks without complications were delivered electively.
MAIN OUTCOME MEASURES: Antenatal days gained; major maternal complications and perinatal survival.
RESULTS: Days gained on the second antihypertensive agent did not differ significantly (P = 0.9), while more days were gained using nifedipine as the crossover 'third agent' (P = 0.01). In the nifedipine group better renal function was recorded, but more cases with isolated low platelet counts occurred. More cases of pulmonary oedema as well as more nonviable mid-trimester and third trimester intrauterine deaths occurred in the prazosin group.
CONCLUSION: Nifedipine and prazosin as second agents allowed comparable amounts of time to be gained, although this changed when used as crossover third-line agents. The efficacy and safety of nifedipine in this study are consistent with the results of other studies. A greater number of intrauterine deaths occurred in the prazosin group.
DESIGN: Randomised controlled trial.
SETTING: Tygerberg Hospital, a tertiary referral centre.
POPULATION: Women with early, severe pre-eclampsia or hypertension in pregnancy, whose blood pressure could not be adequately controlled by methyldopa 2 g/day, but were otherwise stable.
METHODS: Nifedipine or prazosin were given and increased as necessary in a stepwise fashion. Once the maximum dose was reached, the other drug was added in a crossover pattern. Failure to control blood pressure, or the onset of maternal/fetal complications were indications for delivery. Patients reaching a minimum gestation of 34 weeks without complications were delivered electively.
MAIN OUTCOME MEASURES: Antenatal days gained; major maternal complications and perinatal survival.
RESULTS: Days gained on the second antihypertensive agent did not differ significantly (P = 0.9), while more days were gained using nifedipine as the crossover 'third agent' (P = 0.01). In the nifedipine group better renal function was recorded, but more cases with isolated low platelet counts occurred. More cases of pulmonary oedema as well as more nonviable mid-trimester and third trimester intrauterine deaths occurred in the prazosin group.
CONCLUSION: Nifedipine and prazosin as second agents allowed comparable amounts of time to be gained, although this changed when used as crossover third-line agents. The efficacy and safety of nifedipine in this study are consistent with the results of other studies. A greater number of intrauterine deaths occurred in the prazosin group.