Oral nifedipine versus intravenous labetalol for hypertensive emergencies during pregnancy: a systematic review and meta-analysis

Abstract

Aim: The optimal drug management strategy for severe hypertension during pregnancy remains inconclusive. Some randomized controlled trials found that oral nifedipine was more effective than intravenous labetalol in hypertensive emergencies during pregnancy, while others found otherwise. As a result, we conducted a meta-analysis to assess the effectiveness of oral nifedipine versus intravenous labetalol for hypertensive emergencies during pregnancy.

Methods: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials that compared oral nifedipine versus IV labetalol in hypertensive emergencies during pregnancy.

Results: 12 RCTs enrolling 1151 participants (573 in the labetalol group and 578 in the nifedipine group) were included in the meta-analysis. Patients who received oral nifedipine reached their target blood pressure more rapidly than those who received intravenous labetalol (MD 7.64, 95%CI 4.08–11.20, p < .0001). The nifedipine group required fewer doses to achieve the target blood pressure (MD 0.62, 95%CI 0.36 to 0.88, p < .00001). There were no meaningful differences on the maternal complications between the two groups, mainly including eclampsia (OR 1.51; 95% CI, 0.75–3.05; p = .25), headache (OR 0.86; 95% CI, 0.52–1.44; p = .57), nausea/vomiting (OR 1.50; 95% CI, 0.76–2.93; p = .24), hypotension (OR 0.49; 95% CI, 0.12–1.99; p = .32), dizziness (OR 2.01; 95% CI, 0.77–5.25; p = .16), HELLP (OR 0.27; 95% CI, 0.05–1.64; p = .16), palpitations (OR 0.63; 95% CI, 0.32–1.27; p = .20), flushing (OR 0.77; 95%CI, 0.18–3.22; p = .72). There were no significant difference in the neonatal complications, including NICU admission (OR 1.24; 95% CI, 0.87–1.77; p = .23), 5 min Apgar score < 7 (OR 1.07; 95% CI, 0.82–1.39; p = .63), neonatal deaths (OR 1.08; 95%CI, 0.66–1.76; p = .77), FHR abnormality (OR 0.94; 95%CI, 0.47–1.88; p = .86).

Conclusion: In conclusion, oral nifedipine could achieve target blood pressure more rapidly and required fewer doses than intravenous labetalol in the management of hypertensive emergencies during pregnancy.

Keywords:

• Nifedipine
• labetalol
• pregnancy
• randomized controlled trials
• meta analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.