Abstract

Hypertensive disorders of pregnancy, including acute severe hypertension, present significant risks to maternal and fetal health worldwide. The choice of antihypertensive therapy is crucial for timely and effective management. This study aimed to compare the efficacy, safety, and cost-effectiveness of intravenous (I/V) Labetalol and oral Nifedipine in the management of acute severe hypertension during pregnancy. Materials and Methods: A randomized controlled trial was conducted in Pregnant individuals (n=120) with acute severe hypertension. Participants were randomized to receive either I/V Labetalol or oral Nifedipine. The primary outcome was the proportion achieving target blood pressure within specific time frames. Secondary outcomes included time to target blood pressure, adverse events, hospitalization duration, and cost-effectiveness analysis. Results: Both I/V Labetalol and oral Nifedipine effectively lowered blood pressure to the desired range. I/V Labetalol demonstrated a numerically higher proportion of participants achieving the target blood pressure within 15 minutes (75% vs. 61.7%) and achieved the target more rapidly (median time: 19 vs. 25 minutes) compared to Oral Nifedipine. Maternal hypotension and fetal distress incidence did not significantly differ between groups. NICU admissions were similar. Participants in the I/V Labetalol group had a slightly shorter hospitalization duration (4.8 vs. 5.3 days) and lower cost per participant ($550 vs. $600). Conclusion: This study provides valuable insights into the management of acute severe hypertension during pregnancy. Both I/V Labetalol and oral Nifedipine demonstrated efficacy and safety, with I/V Labetalol potentially offering a faster onset of action. Individualized treatment decisions, considering urgency, patient preferences, and cost-effectiveness, are crucial. Further multicenter trials are warranted to optimize hypertensive disorder management during pregnancy.

Description