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Oral labetalol compared to oral nifedipine for postpartum hypertension: A randomized controlled trial.
Hypertens Pregnancy. 2017 Feb; 36(1):44-47.HP

Abstract

OBJECTIVE

To determine whether oral labetalol is associated with a shorter time to blood pressure control compared to oral extended release nifedipine for management of persistent postpartum hypertension.

STUDY DESIGN

This randomized controlled trial conducted between June 2014 and June 2015 included women who delivered at ≥32 weeks' gestation with persistent postpartum hypertension (sustained blood pressure ≥150/100 mmHg) requiring an oral antihypertensive agent. We included women with gestational hypertension, preeclampsia, or chronic hypertension not previously on medication. Women were randomized to labetalol or nifedipine, and the allocated study drug was incrementally increased to achieve blood pressure control. The primary outcome was time to sustained blood pressure control defined as the absence of severe hypertension for at least 12 hours. Secondary outcomes included postpartum length of stay, need for increased dosing, need for additional oral antihypertensive agents, and patient reported side effects. Twenty women were needed in each group as determined by the sample size calculation.

RESULTS

We randomized 25 women to oral labetalol and 25 women to oral extended release nifedipine. The time to achieve BP control was similar between labetalol and nifedipine groups (37.6 hours versus 38.2 hours, p = 0.51). Secondary outcomes including postpartum length of stay, need for increased dosing, and need for additional oral antihypertensive agents were similar between groups. For women discharged on a single agent, significantly more subjects in the labetalol group (16/21) compared to the nifedipine group (10/22) achieved BP control with the initial starting dose (76% versus 46%, p = 0.04). No major side effects were observed. Minor side effects were significantly more common in women taking nifedipine compared to labetalol (48% versus 20%, p = 0.04).

CONCLUSIONS

Both labetalol and nifedipine were effective for control of persistent postpartum hypertension. However, labetalol achieved control significantly more often with the starting dose and had fewer side effects.

CLINICAL TRIAL REGISTRATION

Oral nifedipine versus oral labetalol, NCT02168309. https://clinicaltrials.gov/ct2/show/NCT02168309?term=labetalol+versus+nifedipine&rank=2.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Sharma KJ
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Cedars-Sinai Medical Center , Los Angeles , California , USA.
Greene N
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Cedars-Sinai Medical Center , Los Angeles , California , USA.
Kilpatrick SJ
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Cedars-Sinai Medical Center , Los Angeles , California , USA.

MeSH

AdultAntihypertensive AgentsBlood PressureFemaleHumansHypertensionLabetalolNifedipinePostpartum PeriodPuerperal DisordersTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27786578

Clinical Trial Links

Clinical trial which this article describes
Amlodipine Versus Nifedipine ER for the Management of Postpartum Hypertension

Citation

Sharma, Kathryn J., et al. "Oral Labetalol Compared to Oral Nifedipine for Postpartum Hypertension: a Randomized Controlled Trial." Hypertension in Pregnancy, vol. 36, no. 1, 2017, pp. 44-47.
Sharma KJ, Greene N, Kilpatrick SJ. Oral labetalol compared to oral nifedipine for postpartum hypertension: A randomized controlled trial. Hypertens Pregnancy. 2017;36(1):44-47.
Sharma, K. J., Greene, N., & Kilpatrick, S. J. (2017). Oral labetalol compared to oral nifedipine for postpartum hypertension: A randomized controlled trial. Hypertension in Pregnancy, 36(1), 44-47. https://doi.org/10.1080/10641955.2016.1231317
Sharma KJ, Greene N, Kilpatrick SJ. Oral Labetalol Compared to Oral Nifedipine for Postpartum Hypertension: a Randomized Controlled Trial. Hypertens Pregnancy. 2017;36(1):44-47. PubMed PMID: 27786578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral labetalol compared to oral nifedipine for postpartum hypertension: A randomized controlled trial. AU - Sharma,Kathryn J, AU - Greene,Naomi, AU - Kilpatrick,Sarah J, Y1 - 2016/10/27/ PY - 2016/10/28/pubmed PY - 2017/9/2/medline PY - 2016/10/28/entrez KW - Hypertension KW - preeclampsia KW - randomized controlled trial SP - 44 EP - 47 JF - Hypertension in pregnancy JO - Hypertens Pregnancy VL - 36 IS - 1 N2 - OBJECTIVE: To determine whether oral labetalol is associated with a shorter time to blood pressure control compared to oral extended release nifedipine for management of persistent postpartum hypertension. STUDY DESIGN: This randomized controlled trial conducted between June 2014 and June 2015 included women who delivered at ≥32 weeks' gestation with persistent postpartum hypertension (sustained blood pressure ≥150/100 mmHg) requiring an oral antihypertensive agent. We included women with gestational hypertension, preeclampsia, or chronic hypertension not previously on medication. Women were randomized to labetalol or nifedipine, and the allocated study drug was incrementally increased to achieve blood pressure control. The primary outcome was time to sustained blood pressure control defined as the absence of severe hypertension for at least 12 hours. Secondary outcomes included postpartum length of stay, need for increased dosing, need for additional oral antihypertensive agents, and patient reported side effects. Twenty women were needed in each group as determined by the sample size calculation. RESULTS: We randomized 25 women to oral labetalol and 25 women to oral extended release nifedipine. The time to achieve BP control was similar between labetalol and nifedipine groups (37.6 hours versus 38.2 hours, p = 0.51). Secondary outcomes including postpartum length of stay, need for increased dosing, and need for additional oral antihypertensive agents were similar between groups. For women discharged on a single agent, significantly more subjects in the labetalol group (16/21) compared to the nifedipine group (10/22) achieved BP control with the initial starting dose (76% versus 46%, p = 0.04). No major side effects were observed. Minor side effects were significantly more common in women taking nifedipine compared to labetalol (48% versus 20%, p = 0.04). CONCLUSIONS: Both labetalol and nifedipine were effective for control of persistent postpartum hypertension. However, labetalol achieved control significantly more often with the starting dose and had fewer side effects. CLINICAL TRIAL REGISTRATION: Oral nifedipine versus oral labetalol, NCT02168309. https://clinicaltrials.gov/ct2/show/NCT02168309?term=labetalol+versus+nifedipine&rank=2. SN - 1525-6065 UR - https://www.unboundmedicine.com/medline/citation/27786578/Oral_labetalol_compared_to_oral_nifedipine_for_postpartum_hypertension:_A_randomized_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -