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Hypertension control in pregnancy.

Severe hypertension has serious implications for both mother and fetus in pregnancy. After 24 weeks of gestation, a systolic pressure of 160 mm Hg or a diastolic pressure of ≥ 110 mm Hg is an indication for immediate medication to control the hypertension prior to any other management. Suggested drugs are hydralazine, nifedipine, or labetalol, with a preference for one of the latter two, as hydralazine is linked to hypotension, placental complications, and potential fetal heart rate abnormalities. 
 
A recent randomized trial from Malaysia compared oral nifedipine with intravenous labetalol in situations in which emergency lowering of blood pressure was required.1 Both proved to be safe and effective; nifedipine acted more rapidly (30 min vs 45 min), but over time they were comparable. During the trial the researchers set a target of 150/100 mm Hg for control, which was consistently achieved between 1 and 2 hours, after which maintenance therapy was commenced. 
 
Neither drug had serious side effects and the authors recommend both, but suggest a preference for nifedipine due to the “nonincreasing” dose regimen and the convenience of the oral route of administration.