severe hypertension
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Medicine ◽  
2022 ◽  
Vol 101 (1) ◽  
pp. e28476
Author(s):  
Kinnosuke Matsumoto ◽  
Takayuki Shiroyama ◽  
Kotaro Miyake ◽  
Yuji Yamamoto ◽  
Tomoki Kuge ◽  
...  

Author(s):  
Jeffrey N. Bone ◽  
Ash Sandhu ◽  
Edgardo D. Abalos ◽  
Asma Khalil ◽  
Joel Singer ◽  
...  

Background: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. Methods: Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/ ; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. Results: Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54–0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30–0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44–0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41–0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. Conclusions: In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care.


2022 ◽  
Vol 226 (1) ◽  
pp. S282
Author(s):  
Allison M. Davis ◽  
Christina T. Blanchard ◽  
Akila Subramaniam ◽  
Rachel G. Sinkey ◽  
Alan T. Tita ◽  
...  

2022 ◽  
Vol 226 (1) ◽  
pp. S104-S105
Author(s):  
Eva Hoffmann ◽  
Shena Dillon ◽  
Amarily Barahona ◽  
Donald D. McIntire ◽  
David B. Nelson
Keyword(s):  

2022 ◽  
Vol 226 (1) ◽  
pp. S741-S742
Author(s):  
Robert Martin ◽  
Anne M. Ambia ◽  
Denisse S. Holcomb ◽  
Chet Wells ◽  
Anjali Nambiar ◽  
...  

2022 ◽  
Vol 226 (1) ◽  
pp. S739-S740
Author(s):  
Sumithra Jeganathan ◽  
Cara Staszewski ◽  
Virginia White ◽  
Julie Hemphill ◽  
Leigha Carryl ◽  
...  

2022 ◽  
Vol 226 (1) ◽  
pp. S411
Author(s):  
Jennifer E. Powel ◽  
Alexandra M. Edwards ◽  
Samantha J. Mullan ◽  
Madeline M. L'Ecuyer ◽  
Tracy M. Tomlinson

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