Treatment of acute-onset hypertension in pregnancy: A network meta-analysis of randomized controlled trials comparing anti-hypertensives and route of administration.
Pregnancy
Infant, Newborn
Female
Humans
Antihypertensive Agents
Nifedipine
/ therapeutic use
Ketanserin
/ therapeutic use
Network Meta-Analysis
Pre-Eclampsia
/ drug therapy
Randomized Controlled Trials as Topic
Hypertension
/ drug therapy
Methyldopa
Calcium Channel Blockers
/ therapeutic use
Hydralazine
/ therapeutic use
Antihypertensives
Hypertension
Network meta-analysis
Journal
Pregnancy hypertension
ISSN: 2210-7797
Titre abrégé: Pregnancy Hypertens
Pays: Netherlands
ID NLM: 101552483
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
07
03
2023
revised:
03
07
2023
accepted:
06
10
2023
medline:
5
12
2023
pubmed:
20
10
2023
entrez:
19
10
2023
Statut:
ppublish
Résumé
Consensus on the relative efficacy of available antihypertensive agents used in pregnancy is lacking. To compare treatment success with antihypertensives and categorize by route of administration. MEDLINE, Embase, PubMed, Web of Science, Scopus, CINAHL, and clinicaltrials.gov were searched without date restriction. Peer-reviewed randomized controlled trials (RCTs) comparing pharmacologic agents used to treat hypertension in parturients were included. Evaluated treatment groups included IV-labetalol (BBIV), IV-hydralazine (DIV), oral-nifedipine (CCBPO), sublingual nifedipine (CCBSL), IV-calcium channel blocker (nonspecific)(CCBIV), IV-nitroglycerine (NTG), epoprostenol infusion (PRO), IV-ketanserin (5HT2B), IV-diazoxide (BZO), oral-nifedipine + methyldopa (CCBAG), oral-methyl-dopa (AAG), and oral prazosin (ABPO). Seventy-four studies (8324 patients) were eligible post PRISMA guidelines screening. Results were pooled using a Bayesian-approach for success of treatment (study defined target blood pressure), time to achieve target pressure, and neonatal intensive-care admissions. Treatment success (primary outcome, 55 trials with 5518 patients) was analyzed. Surface under the cumulative ranking curve (SUCRA) was categorized for 13 drugs, CCBPO (0.84) followed by CCBSL (0.78) were most likely to be effective in achieving target blood pressure. After sub-grouping by presence/absence of preeclampsia, CCB-PO ranked highest for both [(0.82) vs. (0.77), respectively]. Serotonin antagonists (0.99) and nitroglycerin (0.88) ranked highest for time to target pressure. NICU admissions were lowest for alpha-2 agonists (0.89), followed by BB PO (0.82) and hydralazine IV (0.49). Oral calcium-channel blockers ranked highest for treatment success. Ketanserin achieved target blood pressure fastest, warranting additional research. The results should be interpreted with caution as SUCRA values may not indicate whether the differences between interventions have clinically meaningful effect sizes.
Sections du résumé
BACKGROUND
BACKGROUND
Consensus on the relative efficacy of available antihypertensive agents used in pregnancy is lacking.
OBJECTIVE
OBJECTIVE
To compare treatment success with antihypertensives and categorize by route of administration.
SEARCH STRATEGY
METHODS
MEDLINE, Embase, PubMed, Web of Science, Scopus, CINAHL, and clinicaltrials.gov were searched without date restriction.
DATA COLLECTION
METHODS
Peer-reviewed randomized controlled trials (RCTs) comparing pharmacologic agents used to treat hypertension in parturients were included. Evaluated treatment groups included IV-labetalol (BBIV), IV-hydralazine (DIV), oral-nifedipine (CCBPO), sublingual nifedipine (CCBSL), IV-calcium channel blocker (nonspecific)(CCBIV), IV-nitroglycerine (NTG), epoprostenol infusion (PRO), IV-ketanserin (5HT2B), IV-diazoxide (BZO), oral-nifedipine + methyldopa (CCBAG), oral-methyl-dopa (AAG), and oral prazosin (ABPO).
ANALYSIS
METHODS
Seventy-four studies (8324 patients) were eligible post PRISMA guidelines screening. Results were pooled using a Bayesian-approach for success of treatment (study defined target blood pressure), time to achieve target pressure, and neonatal intensive-care admissions.
RESULTS
RESULTS
Treatment success (primary outcome, 55 trials with 5518 patients) was analyzed. Surface under the cumulative ranking curve (SUCRA) was categorized for 13 drugs, CCBPO (0.84) followed by CCBSL (0.78) were most likely to be effective in achieving target blood pressure. After sub-grouping by presence/absence of preeclampsia, CCB-PO ranked highest for both [(0.82) vs. (0.77), respectively]. Serotonin antagonists (0.99) and nitroglycerin (0.88) ranked highest for time to target pressure. NICU admissions were lowest for alpha-2 agonists (0.89), followed by BB PO (0.82) and hydralazine IV (0.49).
CONCLUSION
CONCLUSIONS
Oral calcium-channel blockers ranked highest for treatment success. Ketanserin achieved target blood pressure fastest, warranting additional research. The results should be interpreted with caution as SUCRA values may not indicate whether the differences between interventions have clinically meaningful effect sizes.
Identifiants
pubmed: 37857042
pii: S2210-7789(23)00230-1
doi: 10.1016/j.preghy.2023.10.005
pii:
doi:
Substances chimiques
Antihypertensive Agents
0
Nifedipine
I9ZF7L6G2L
Ketanserin
97F9DE4CT4
Methyldopa
56LH93261Y
Calcium Channel Blockers
0
Hydralazine
26NAK24LS8
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
74-82Informations de copyright
Copyright © 2023. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.