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The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy.
Pregnancy Hypertens. 2018 Jan; 11:92-98.PH

Abstract

AIM

To compare the blood pressure (BP) lowering effects of labetalol and nifedipine modified release (MR) in hypertensive pregnant women. We also investigated the effect on the heart rate (HR) and determined the proportion of time spent in target.

METHODS

This was an exploratory study. Women with chronic hypertension taking either labetalol or nifedipine were offered 24-h ambulatory blood pressure monitoring (ABPM). Sleep, wake and drug ingestion times were self-reported. An indirect response model was used to analyse the systolic BP (SBP), diastolic BP (DBP) and HR time-series; the effect of gestation and type of drug was evaluated.

RESULTS

Forty-eight women were recruited: 24 in each group. There was no difference in clinical characteristics. In women taking nifedipine there was a positive association between the dose of nifedipine and pre-dose BP p = .002, this was not present in the labetalol group. There was a difference between the drug effects on both the SBP and DBP time-series (p = .014). In comparison to labetalol, there was less variation in day time BP in those women prescribed nifedipine. Women on labetalol spent a larger proportion of time with their DBP below target (<80 mmHg). The HR dynamics were qualitatively different, a stimulatory effect was found with nifedipine compared to an inhibitory effect with labetalol.

CONCLUSION

There are significant and important differences between the BP lowering effects of nifedipine and labetalol. A large randomised control trial is required to investigate the relationship between BP variability and time in target on pregnancy outcomes.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Shawkat E
Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom. Electronic address: emmashawkat@yahoo.co.uk.
Mistry H
Division of Pharmacy, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom.
Chmiel C
Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom.
Webster L
Women's Health Academic Centre, King's College London, London WC2R 2LS, United Kingdom.
Chappell L
Women's Health Academic Centre, King's College London, London WC2R 2LS, United Kingdom.
Johnstone ED
Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom.
Myers JE
Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom.

MeSH

Adrenergic AntagonistsAntihypertensive AgentsBlood PressureCalcium Channel BlockersChronic DiseaseDelayed-Action PreparationsFemaleHeart RateHumansHypertension, Pregnancy-InducedLabetalolNifedipinePregnancyTime FactorsTreatment OutcomeVasodilator Agents

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29523282

Citation

Shawkat, E, et al. "The Effect of Labetalol and Nifedipine MR On Blood Pressure in Women With Chronic Hypertension in Pregnancy." Pregnancy Hypertension, vol. 11, 2018, pp. 92-98.
Shawkat E, Mistry H, Chmiel C, et al. The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy. Pregnancy Hypertens. 2018;11:92-98.
Shawkat, E., Mistry, H., Chmiel, C., Webster, L., Chappell, L., Johnstone, E. D., & Myers, J. E. (2018). The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy. Pregnancy Hypertension, 11, 92-98. https://doi.org/10.1016/j.preghy.2017.12.007
Shawkat E, et al. The Effect of Labetalol and Nifedipine MR On Blood Pressure in Women With Chronic Hypertension in Pregnancy. Pregnancy Hypertens. 2018;11:92-98. PubMed PMID: 29523282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy. AU - Shawkat,E, AU - Mistry,H, AU - Chmiel,C, AU - Webster,L, AU - Chappell,L, AU - Johnstone,E D, AU - Myers,J E, Y1 - 2018/01/02/ PY - 2017/07/27/received PY - 2017/11/28/revised PY - 2017/12/30/accepted PY - 2018/3/11/entrez PY - 2018/3/11/pubmed PY - 2018/9/18/medline KW - Ambulatory blood pressure monitoring KW - Antihypertensives KW - Blood pressure control KW - Chronic hypertension KW - Labetalol KW - Nifedipine MR SP - 92 EP - 98 JF - Pregnancy hypertension JO - Pregnancy Hypertens VL - 11 N2 - AIM: To compare the blood pressure (BP) lowering effects of labetalol and nifedipine modified release (MR) in hypertensive pregnant women. We also investigated the effect on the heart rate (HR) and determined the proportion of time spent in target. METHODS: This was an exploratory study. Women with chronic hypertension taking either labetalol or nifedipine were offered 24-h ambulatory blood pressure monitoring (ABPM). Sleep, wake and drug ingestion times were self-reported. An indirect response model was used to analyse the systolic BP (SBP), diastolic BP (DBP) and HR time-series; the effect of gestation and type of drug was evaluated. RESULTS: Forty-eight women were recruited: 24 in each group. There was no difference in clinical characteristics. In women taking nifedipine there was a positive association between the dose of nifedipine and pre-dose BP p = .002, this was not present in the labetalol group. There was a difference between the drug effects on both the SBP and DBP time-series (p = .014). In comparison to labetalol, there was less variation in day time BP in those women prescribed nifedipine. Women on labetalol spent a larger proportion of time with their DBP below target (<80 mmHg). The HR dynamics were qualitatively different, a stimulatory effect was found with nifedipine compared to an inhibitory effect with labetalol. CONCLUSION: There are significant and important differences between the BP lowering effects of nifedipine and labetalol. A large randomised control trial is required to investigate the relationship between BP variability and time in target on pregnancy outcomes. SN - 2210-7797 UR - https://www.unboundmedicine.com/medline/citation/29523282/The_effect_of_labetalol_and_nifedipine_MR_on_blood_pressure_in_women_with_chronic_hypertension_in_pregnancy_ DB - PRIME DP - Unbound Medicine ER -