Meta AnalysisID 3671
硝苯地平对比拉贝洛尔治疗妊娠期高血压危象：一项系统评价与Meta分析
CRD42014008763
Which drug out of labetalol and nifedipine which is more efficacious and safer when used to lower blood pressure in hypertensive crisis of pregnancy
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Record Fields
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- Meta Analysis Id
- 3671
- Evidence Id
- 12229
- Core Evidence Id
- 12229
- Source Meta Analysis Id
- 3631
- Herb2 Meta Analysis Id
- HBMA003631
- Crd Id
- CRD42014008763
- Title
- Nifedipine vs. labetalol for treatment of hypertensive crisis during pregnancy: a systematic review and meta-analysis
- Review Question
- Which drug out of labetalol and nifedipine which is more efficacious and safer when used to lower blood pressure in hypertensive crisis of pregnancy
- Study Type Included
- We will include randomized controlled trials (RCT) and quasi RCT's comparing intravenous labetalol with oral nifedipine for treatment of severe hypertension (defined) during pregnancy with relevant outcomes addressing maternal, perinatal or pediatric benefit or risks. Studies published only as abstract will be included provided there is sufficient information presented in the abstract to demonstrate that it meets the inclusion criteria and is of an acceptable methodological standard.
- Condition Being Studied
- All types of hypertensive disorders of pregnancy can be complicated by acute elevations of blood pressure to dangerously high levels which poses a serious threat of cerebrovascular and cardiovascular complications. This clinical condition demands hospitalization of the woman for rapid but smooth lowering of the blood pressure to safe levels with antihypertensive drugs. A number of drugs have been used for this condition in clinical and research setting. However, the most commonly recommended drugs are hydralazine, labetalol and nifedipine. Hydralazine has been used extensively and had been the criterion standard for a long time. Recent times have witnessed a decline in the use of hydralazine, attributable to; publication of a meta analysis which compared hydralazine with other anti hypertensive drugs and found worrisome maternal and fetal side effects associated with its use. Manufacturing shortages have also made it unavailable in many areas of the world. This was followed by Cochrane systematic review on drugs for hypertensive crisis of pregnancy. Authors opined that at present there is insufficient evidence to choose one drug as the best drug for this clinical condition however nifedipine use was associated with less chances of persistent hypertension when compared with hydralazine and safer when compared with labetalol. Due to reason listed above, labetalol and nifedipine are the most preferred drugs for lowering blood pressure in hypertensive crisis of pregnancy in many parts of the world presently. However their comparative efficacy is speculative. Surprisingly, despite being used most commonly, there is least data on the head on comparison of these two drugs. This is reflected even in the cochrane systematic review when these two drugs were compared for maternal and child outcomes directly. Data from only two trials (small size) could be used.
- Participant
- Undelivered pregnant women who are at gestation >= 20 weeks with severe hypertension. Severe hypertension will be defined as systolic blood pressure of >= 160 mm Hg and or diastolic blood pressure >= 105 mm Hg.
- Animal
- Human Disease Modelled
- Intervention
- Oral nifedipine for lowering of severely raised blood pressure during pregnancy regardless of dose, frequency or duration of therapy.
- Comparator Control
- Intravenous labetalol for lowering of severely raised blood pressure during pregnancy regardless of dose, frequency or duration of therapy.
- Main Outcome
- For the woman: 1. Persistent high blood pressure: defined, if possible, as either the need for an antihypertensive drug other than the allocated treatment, or failure to lower the blood pressure to safe levels with the allocated treatment. 2. Death: death during hospital stay. 3. Maternal Hypotension (low blood pressure): defined as systolic blood pressure of <90 mm Hg and or diastolic blood pressure of < 60 mm Hg or low blood pressure causing clinical problems. 4. Severe maternal morbidity (eclampsia, stroke, placental abruption, disseminated intravascular coagulation, kidney failure, liver failure, pulmonary edema) For the Child: 1. Death (in utero or neonatal) within seven days of the trial 2. Perinatal mortality 3. FHR abnormalities: within trial period (defined as from administration of the first dose to the commencement of maintenance therapy after initial lowering of very high blood pressure to safe levels)
- Outcome Measure
- Additional Outcome
- For the woman: 1. Prolongation/ lengthening of pregnancy in days 2.Side effects 3. Admission to intensive care 4. Emergency termination of pregnancy For the child: 1. Low Apgar score (<7) at 5 minutes 2. neonatal intensive care unit admission
- Study Method
- Intervention, Meta-analysis
- Keyword
- Humans; Hypertension; Labetalol; Nifedipine; Pregnancy;
- Contact
- Shashank Shekhar [email protected]
- Organisational Affiliation
- Funding Source
- Other Selection Criteria
- Final Publication
- Same Topic Review
- Published Protocol
- Review Type
- Language
- English
- Country
- India
- Review Stage
- Review Ongoing
- First Submission Date
- Registration Date
- 2014-02-28
- Anticipated Start Date
- 2014-03-03
- Anticipated Completion Date
- 2014-06-30
- Title Cn
- 硝苯地平对比拉贝洛尔治疗妊娠期高血压危象：一项系统评价与Meta分析
- Title En
- Nifedipine vs. labetalol for treatment of hypertensive crisis during pregnancy: a systematic review and meta-analysis
- Bilingual Status
- complete