• I A Raheem, R Saaid, S Z Omar, and P C Tan.
• Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• BJOG. 2012 Jan 1; 119 (1): 78-85.

ObjectiveTo compare oral nifedipine with intravenous labetalol in their rapidity to control hypertensive emergencies of pregnancy.DesignA double-blind randomised trial.SettingA university hospital in Malaysia.PopulationPregnant women with severe gestational hypertension≥160/110 mmHg who required immediate treatment.MethodsPatients were randomised to receive nifedipine (10 mg tablet, orally, up to five doses) and intravenous placebo saline injection or intravenous labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) and a placebo tablet every 15 minutes until the target blood pressure of ≤150/100 mmHg was achieved. Crossover treatment was effected if the initial treatment regimen was unsuccessful. MAIN OUTCOME MEASURE  The time taken to achieve a blood pressure of ≤150/100 mmHg.ResultsThe median time taken to achieve target blood pressure was 30 minutes (interquartile range, IQR 22.5-67.5 minutes) versus 45 minutes (IQR 30-60 minutes) for nifedipine and labetalol, respectively (P=0.59). Repeated measures analysis of variance indicated that in the first hour both systolic (F=87.6, P<0.001) and diastolic (F=55.8, P<0.001) blood pressure significantly decreased, but there was no difference between the nifedipine and labetalol groups for both systolic (F=0.12, P=0.74) and diastolic (F=0.92, P=0.34) blood pressure trends over time. Crossover treatment was required in 20% of women from each group.ConclusionsOral nifedipine and intravenous labetalol regimens are similarly effective in the acute control of severe hypertension in pregnancy.© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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