Ocílio Ribeiro Gonçalves , Lucas Cael Azevedo Ramos Bendaham , Gabriel Henrique Simoni , Giovana Schlichta Adriano Kojima , Hilária Saugo Faria , Victoria Städler de Abreu , Arlindo Bispo da Silva Júnior , Victor Gonçalves Soares , Bianca Leal Ribeiro , Benjamim Barbosa de Azevedo , Keliany Carla Duarte de Araújo Melo , Cynthia Dantas de Macedo Lins
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In cases of acute hypertension, several pharmacological interventions are available to lower blood pressure, such as hydralazine, a direct arteriolar vasodilator, and labetalol, a combined alpha and beta-blocker.</div></div><div><h3>Objectives</h3><div>This systematic review and <em>meta</em>-analysis of randomized controlled trials (RCTs) aims to compare the efficacy and safety of intravenous labetalol and intravenous hydralazine for acute hypertensive disorders during pregnancy.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase and Cochrane for studies comparing labetalol versus hydralazine in pregnant patients. The primary outcomes were median arterial blood pressure (MABP), diastolic blood pressure (DBP) and systolic blood pressure (SBP). We performed statistical analyses using R 4.1.1. Heterogeneity was examined with the Cochran Q test and I<sup>2</sup> statistics. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI), were computed with a random-effects model.</div></div><div><h3>Results</h3><div>Nineteen RCTs were included in this <em>meta</em>-analysis, comprising 2,261 patients. Among them, 1,131 (50 %) received treatment with labetalol. There was no statistically significant difference between groups in terms of SBP (MD −1.74; 95 % CI −6.72 to 3.23; p = 0.49; I<sup>2</sup> = 93 %), MABP (MD −0.72; 95 % CI −2.34 to 0.90; p = 0.39; I<sup>2</sup> = 0 %), DBP (MD 0.25; 95 % CI −4.72 to 5.21; p = 0.92; I<sup>2</sup> = 96 %), tachycardia (RR 0.42; 95 % CI 0.15 to 1.18; p = 0.099; I<sup>2</sup> = 41 %), and placenta abruption (RR 0.42; 95 % CI 0.15 to 1.16; p = 0.093; I<sup>2</sup> = 0 %). However, labetalol significantly reduced maternal hypotension (RR 0.26; 95 % CI 0.21 to 0.33; p < 0.001; I<sup>2</sup> = 41 %) compared with hydralazine.</div></div><div><h3>Conclusion</h3><div>This systematic review and <em>meta</em>-analysis of RCTs found that labetalol and hydralazine were efficient for hypertension disorders in pregnancy. However, labetalol reduced the incidence of maternal hypotension.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 337-344"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative efficacy and safety between intravenous labetalol and intravenous hydralazine for hypertensive disorders in pregnancy: A systematic review and meta-analysis of 19 randomized controlled trials\",\"authors\":\"Ocílio Ribeiro Gonçalves , Lucas Cael Azevedo Ramos Bendaham , Gabriel Henrique Simoni , Giovana Schlichta Adriano Kojima , Hilária Saugo Faria , Victoria Städler de Abreu , Arlindo Bispo da Silva Júnior , Victor Gonçalves Soares , Bianca Leal Ribeiro , Benjamim Barbosa de Azevedo , Keliany Carla Duarte de Araújo Melo , Cynthia Dantas de Macedo Lins\",\"doi\":\"10.1016/j.ejogrb.2024.11.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Hypertensive disorders during pregnancy elevate the likelihood of unfavorable outcomes for both mother and fetus. In cases of acute hypertension, several pharmacological interventions are available to lower blood pressure, such as hydralazine, a direct arteriolar vasodilator, and labetalol, a combined alpha and beta-blocker.</div></div><div><h3>Objectives</h3><div>This systematic review and <em>meta</em>-analysis of randomized controlled trials (RCTs) aims to compare the efficacy and safety of intravenous labetalol and intravenous hydralazine for acute hypertensive disorders during pregnancy.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase and Cochrane for studies comparing labetalol versus hydralazine in pregnant patients. The primary outcomes were median arterial blood pressure (MABP), diastolic blood pressure (DBP) and systolic blood pressure (SBP). We performed statistical analyses using R 4.1.1. Heterogeneity was examined with the Cochran Q test and I<sup>2</sup> statistics. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI), were computed with a random-effects model.</div></div><div><h3>Results</h3><div>Nineteen RCTs were included in this <em>meta</em>-analysis, comprising 2,261 patients. Among them, 1,131 (50 %) received treatment with labetalol. There was no statistically significant difference between groups in terms of SBP (MD −1.74; 95 % CI −6.72 to 3.23; p = 0.49; I<sup>2</sup> = 93 %), MABP (MD −0.72; 95 % CI −2.34 to 0.90; p = 0.39; I<sup>2</sup> = 0 %), DBP (MD 0.25; 95 % CI −4.72 to 5.21; p = 0.92; I<sup>2</sup> = 96 %), tachycardia (RR 0.42; 95 % CI 0.15 to 1.18; p = 0.099; I<sup>2</sup> = 41 %), and placenta abruption (RR 0.42; 95 % CI 0.15 to 1.16; p = 0.093; I<sup>2</sup> = 0 %). 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引用次数: 0
摘要
引言妊娠期高血压疾病会增加对母亲和胎儿不利的可能性。在急性高血压的情况下，有几种药物可用于降低血压，如肼屈嗪（一种直接扩张动脉血管的药物）和拉贝洛尔（一种α和β联合受体阻滞剂）：本研究对随机对照试验（RCTs）进行了系统回顾和荟萃分析，旨在比较静脉注射拉贝洛尔和静脉注射水拉嗪治疗妊娠期急性高血压疾病的有效性和安全性：我们系统地检索了 PubMed、Embase 和 Cochrane 中对妊娠期患者使用拉贝洛尔和肼屈嗪进行比较的研究。主要结果为中位动脉血压（MABP）、舒张压（DBP）和收缩压（SBP）。我们使用 R 4.1.1 进行了统计分析。异质性采用 Cochran Q 检验和 I2 统计量进行检验。采用随机效应模型计算风险比（RR）和平均差（MD）及 95% 置信区间（CI）：本次荟萃分析共纳入 19 项研究，包括 2,261 名患者。其中 1,131 人（50%）接受了拉贝洛尔治疗。在 SBP（MD -1.74; 95 % CI -6.72 to 3.23; p = 0.49; I2 = 93 %）、MABP（MD -0.72; 95 % CI -2.34 to 0.90; p = 0.39; I2 = 0 %）、DBP（MD 0.25; 95 % CI -4.72 to 5.21; p = 0.92; I2 = 96 %）、心动过速（RR 0.42; 95 % CI 0.15 to 1.18; p = 0.099; I2 = 41 %）和胎盘早剥（RR 0.42; 95 % CI 0.15 to 1.16; p = 0.093; I2 = 0 %）。然而，与肼屈嗪相比，拉贝洛尔能显著降低产妇低血压（RR 0.26；95 % CI 0.21 至 0.33；p 2 = 41 %）：这项系统性回顾和荟萃分析研究发现，拉贝洛尔和氢氯吡嗪对妊娠期高血压疾病有很好的疗效。然而，拉贝洛尔降低了产妇低血压的发生率。
Comparative efficacy and safety between intravenous labetalol and intravenous hydralazine for hypertensive disorders in pregnancy: A systematic review and meta-analysis of 19 randomized controlled trials
Introduction
Hypertensive disorders during pregnancy elevate the likelihood of unfavorable outcomes for both mother and fetus. In cases of acute hypertension, several pharmacological interventions are available to lower blood pressure, such as hydralazine, a direct arteriolar vasodilator, and labetalol, a combined alpha and beta-blocker.
Objectives
This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to compare the efficacy and safety of intravenous labetalol and intravenous hydralazine for acute hypertensive disorders during pregnancy.
Methods
We systematically searched PubMed, Embase and Cochrane for studies comparing labetalol versus hydralazine in pregnant patients. The primary outcomes were median arterial blood pressure (MABP), diastolic blood pressure (DBP) and systolic blood pressure (SBP). We performed statistical analyses using R 4.1.1. Heterogeneity was examined with the Cochran Q test and I2 statistics. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI), were computed with a random-effects model.
Results
Nineteen RCTs were included in this meta-analysis, comprising 2,261 patients. Among them, 1,131 (50 %) received treatment with labetalol. There was no statistically significant difference between groups in terms of SBP (MD −1.74; 95 % CI −6.72 to 3.23; p = 0.49; I2 = 93 %), MABP (MD −0.72; 95 % CI −2.34 to 0.90; p = 0.39; I2 = 0 %), DBP (MD 0.25; 95 % CI −4.72 to 5.21; p = 0.92; I2 = 96 %), tachycardia (RR 0.42; 95 % CI 0.15 to 1.18; p = 0.099; I2 = 41 %), and placenta abruption (RR 0.42; 95 % CI 0.15 to 1.16; p = 0.093; I2 = 0 %). However, labetalol significantly reduced maternal hypotension (RR 0.26; 95 % CI 0.21 to 0.33; p < 0.001; I2 = 41 %) compared with hydralazine.
Conclusion
This systematic review and meta-analysis of RCTs found that labetalol and hydralazine were efficient for hypertension disorders in pregnancy. However, labetalol reduced the incidence of maternal hypotension.
期刊介绍：
The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.
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