COMPARISON OF OUTCOME OF ORAL NIFEDIPINE VERSUS INTRAVENOUS HYDRALAZINE AS ANTIHYPERTENSIVE THERAPY IN THE MANGMENT OF PATIENTS WITH SEVERE PREECLAMPSIA

Abstract

BACKGROUND: Severe preeclampsia is a disorder of pregnancy after 20 weeks gestation. The goal of managing preeclampsia is to keep blood pressure of woman in the normal range with anti-hypertensive and prevent the development of complications like eclampsia. Few studies have compared the effectiveness of oral nifedipine with intravenous hydralazine in pre-eclamptic women.

OBJECTIVE: To compare the outcome of oral nifedipine versus intravenous hydralazine as antihypertensive therapy for the management of severe pre-eclampsia

Study setting: The study was conducted at Obstetrics & Gynecology Department, Allama Iqbal Memorial Teaching Hospital, Sialkot.

Duration of study: August 20, 2020 to February 20, 2021.

Study design: Randomized controlled trial.

METHODOLOGY: Total 70(35 in each group) participants with sever preeclampsia were enrolled. All the patients were divided into Group A (oral nifedipine) or Group B (IV hydralazine). All the patients in Group-A were given oral nifedipine in the form of 10 mg tablets and every 15 minutes upto five doses or the desired blood pressure achieved. Group-B patients received intravenous hydralazine injection in a dose regimen of 5 mg I/V, every 15 minutes upto five doses or desired blood pressure achieved. Clinical response to therapy for both drugs was calculated in term of outcome. All the data were entered & analyzed by using SPSS v25.0. The comparison of outcome was tested for significance by t-test. Effect modifiers like age, gestational age, parity and BMI were controlled by stratification. Post-stratification t-test was applied. A p-value ≤ 0.05 was considered significant.

RESULTS: The msean time to achieve desired blood pressure in oral nifedipine group was 51.68±5.96 minutes and 39.78±5.15 minutes in IV hydralazine group with a p-value of 0.0001, which is statistically significant. The mean number of doses required to achieve desired blood pressure in oral nifedipine group was 5.13±0.72 and 3.80±0.43 in IV hydralazine group with a p-value of 0.00001, which is statistically significant.

CONCLUSION: This study supports the use of either hydralazine or nifedipine for blood pressure control in acute hypertensive emergencies in pregnancy with hydralazine being more effective and side effects being non-significant.