Intravenous labetalol versus oral nifedipine for acute hyper
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Pregnant women with preeclampsia have been shown to have elevated cerebral perfusion pressure and impaired cerebral autoregulation compared to normal pregnant women. Transcranial Doppler is a non-invasive technique used to estimate cerebral perfusion pressure. The effects of different antihypertensives on cerebral perfusion pressure in preeclampsia is unknown. Study was conducted to compare the change in cerebral perfusion pressure before and after intravenous labetalol versus oral nifedipine in the setting of acute, severe hypertension in pregnancy.

Sixteen women with acute, severe hypertension were enrolled; 8 received intravenous labetalol, and 8 received oral nifedipine. There were no significant differences between the labetalol and nifedipine groups for baseline characteristics including maternal age, race and ethnicity, payment, hospital site, body mass index, nulliparity, gestational age, pre-existing diabetes mellitus or chronic hypertension, fetal growth restriction, magnesium sulfate, or symptomatology. When examined 30 minutes after the administration of either intravenous labetalol or oral nifedipine, there was a significantly greater decrease in systolic blood pressure (-9.8 mmHg versus -39 mmHg), mean arterial pressure (-7.1 mmHg versus -22.3 mmHg), and cerebral perfusion pressure (-2.5 mmHg versus -27.7 mmHg) in the nifedipine group. There was no statistically significant decrease in diastolic pressure (-12.9 mmHg versus -5.4 mmHg). The change in middle cerebral artery velocity by transcranial Doppler was compared between the groups and was not different (.07 cm/s vs .16 cm/s).

In conclusion, Oral nifedipine resulted in a significant decrease in cerebral perfusion pressure, while labetalol did not, following administration for acute, severe hypertension among women with preeclampsia. This decrease appears to be driven by a decrease in peripheral arterial blood pressure rather than a direct change in cerebral blood flow.

Dr. R●●a G●●g
Dr. R●●a G●●g Obstetrics and Gynaecology
I m highly interested to further this research
Jun 20, 2020Like