Efficacy and Perinatal Safety of Intravenous Hydralazine versus Oral Labetalol in the Acute Management of Severe Pregnancy-Induced Hypertension

International Journal of Medicine and Medical Sciences | Vol. 12, No. 11, November 2022 | pp. 81–88

DOI: 10.46882/2022/IJMMS/120081

Original Research Article

Efficacy and Perinatal Safety of Intravenous Hydralazine versus Oral Labetalol in the Acute Management of Severe Pregnancy-Induced Hypertension

Fatima Z. Bello¹, Kwaku A. Mensah², Grace N. Ojo¹*

¹Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria.

²Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Abstract:

Acute hypertensive crises during pregnancy require rapid, safe therapeutic containment to avoid maternal cerebrovascular injuries or fetal distress. This randomized, open-label, comparative clinical trial evaluated the efficacy and perinatal safety of intravenous hydralazine versus oral labetalol in the acute reduction of severe pregnancy-induced hypertension. A total of 160 third-trimester pregnant women with a blood pressure ≥ 160/110 mmHg were randomly assigned to receive either intravenous hydralazine (5 mg bolus, repeated every 20 minutes up to 20 mg, n = 80) or oral labetalol (200 mg initial dose, repeated up to 600 mg, n = 80). The primary outcomes were the time required to achieve a safe target blood pressure (≤ 140/90 mmHg) and the incidence of maternal and perinatal complications. Both interventions effectively lowered blood pressure; however, the mean time to achieve target stabilization was significantly shorter in the intravenous hydralazine group (32.4 ± 6.2 minutes) compared to the oral labetalol group (46.8 ± 8.5 minutes, p < 0.01). The total number of doses required was lower in the hydralazine arm. Maternal adverse events, specifically persistent tachycardia (18.8% vs. 5.0%, p < 0.05) and headaches (22.5% vs. 7.5%, p < 0.01), were significantly higher in the hydralazine cohort. There were no statistically significant differences between the groups regarding the incidence of fetal bradycardia or low Apgar scores at 5 minutes (p > 0.05). Both therapeutic agents are effective, but intravenous hydralazine offers more rapid blood pressure control, though it causes higher rates of minor maternal adverse effects.

Keywords: Pregnancy-Induced Hypertension, Severe Pre-eclampsia, Hydralazine, Labetalol, Antihypertensive Therapy, Perinatal Safety

Manuscript Timeline: Received: August 14, 2022; Revised: September 22, 2022; Accepted: October 10, 2022; Published: November 11, 2022.

Citation: Bello FZ, Mensah KA, Ojo GN. Efficacy and Perinatal Safety of Intravenous Hydralazine versus Oral Labetalol in the Acute Management of Severe Pregnancy-Induced Hypertension. International Journal of Medicine and Medical Sciences, 2022, 12(11): 81–88. DOI: 10.46882/2022/IJMMS/120081

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