Calcium channel blockers for inhibiting preterm labour; a systematic review of the evidence and a protocol for administration of nifedipine

1,4-Dihydropyridines are a group of pyridine-based molecules possessing a magnificent set of biological and therapeutic potentials. Belonging to the class of calcium channel blockers, they are known to be effective in the conditions, angina, hypertension, myocardial infarction and show vasodilatory and cardiac depressant effects. Hypotensive, antimicrobial, anticancer, anticoagulant, antioxidant, anticonvulsant, antimalarial, antiulcer, and neuroprotective effects have been reported with their rational use. The effects are precipitated in response to inhibition of calcium channels, gradually restricting calcium influx. Drugs like nifedipine, felodipine, and amlodipine are commonly used clinically. Several other drugs belonging to this class have been under clinical trials. The present review focuses on the various 1,4-dihydropyridine derivatives and their pharmacological actions.

Download Full-text

Are Calcium-Channel Blockers the Most Effective Anti-hypertensive Agent in Black Women With Hypertensive Disorders of Pregnancy? A Systematic Review

10.21203/rs.3.rs-408744/v1 ◽

2021 ◽

Author(s):

Jeeva Reeba John ◽

Gwenetta Curry

Keyword(s):

Systematic Review ◽

Black Women ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Randomised Control Trial ◽

Channel Blockers ◽

Hypertensive Disorders ◽

Black Patients ◽

Randomised Control Trials ◽

In Pregnancy

Abstract BackgroundBlack women are four times more likely to die than White women due to complications during pregnancy or childbirth in the U.K. This cohort are also more prone to Hypertensive Disorders in Pregnancy (HDP). Outside of pregnancy, there are race based differences in the management of hypertension as Calcium-Channel Blockers (CCB) are more effective in reducing blood pressure in Black patients. It is unclear whether these differences in anti-hypertensive management extend to the management of hypertension in pregnancy. The primary objective was to address this gap in evidence by undertaking a systematic review of randomised control trials, where one treatment arm comprised of CCBs, investigating pharmacological management of HDP to assess whether CCBs are the most effective anti-hypertensive agent in Black pregnant women.MethodsThe following electronic databases were searched: MEDLINE and Embase. We used MeSH and free text terms in conjunction to increase sensitivity to potentially relevant studies. Inclusion criteria included: (1) study involved drug treatment of HDP; (2) study was of randomised control trial design; (3) one of the treatment arms involved CCBs (4) English full-text and (5) outcome data was stratified by race, and included Black women. Information regarding baseline participant data, type of anti-hypertensive, and clinical outcomes was extracted from each study.ResultsThis review highlighted four randomised control trials, which published race or ethnicity demographics, with only one trial that stratified HDP outcomes by ethnicity. ConclusionsThere is a lack of evidence to draw definite conclusions as to whether CCBs are the most effective anti-hypertensive agent for Black patients with HDP, highlighting the need for further research in this area. However, this review demonstrates some evidence to support the hypothesis that CCBs could be more effective in the management of HDP in Black patients and that Labetalol, which is the current first-line management of HDP, may not represent the gold standard of treatment in this cohort.

Download Full-text