Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India.
Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India.
BJOG. 2016 Jan;123(1):40-7. doi: 10.1111/1471-0528.13463. Epub 2015 Jun 26.
Oral nifedipine is recommended along with labetalol and hydralazine for treatment of severe hypertension during pregnancy by most authorities. Although nifedipine is cheap and easily administered, the usage pattern among health care providers suggests a strong preference for labetalol despite lack of evidence for the same.
To determine the efficacy and safety of oral nifedipine for treatment of severe hypertension of pregnancy compared with intravenous labetalol.
We systematically searched for articles comparing oral nifedipine with intravenous labetalol for the treatment of severe hypertension during pregnancy in any language, over Medline, Cochrane Central Register of Clinical Trials and Google Scholar from inception till February 2014.
We included all RCTs that compared intravenous labetalol with oral nifedipine for treatment of severe hypertension during pregnancy, addressing relevant efficacy and safety outcomes.
Eligible studies were reviewed, and data were extracted onto a standard form. We used Cochrane review manager software for quantitative analysis. Data were analysed using a fixed effect model.
The pooled analysis of seven trials (four from developing countries) consisting of 363 woman-infant pairs showed that oral nifedipine was associated with less risk of persistent hypertension (RR 0.42, 95% CI 0.18-0.96) and reported maternal side effects (RR 0.57, 95% CI 0.35-0.94). However, on sensitivity analysis the outcome 'persistent hypertension' was no longer significant. Other outcomes did not reach statistical significance.
Oral nifedipine is as efficacious and safe as intravenous labetalol and may have an edge in low resource settings.
Although studies to date are few in number and small, nifedipine shows promise for severe hypertension in pregnancy.
大多数权威机构推荐在治疗妊娠重度高血压时使用口服硝苯地平、拉贝洛尔和肼屈嗪。尽管硝苯地平价格便宜且易于给药，但医疗保健提供者的使用模式表明，尽管缺乏证据支持，但他们强烈倾向于使用拉贝洛尔。
确定与静脉注射拉贝洛尔相比，口服硝苯地平治疗妊娠重度高血压的疗效和安全性。
我们系统地搜索了比较口服硝苯地平与静脉注射拉贝洛尔治疗妊娠重度高血压的文章，语言不限，检索范围包括 Medline、Cochrane 临床试验中心注册库和 Google Scholar，检索时间截至 2014 年 2 月。
我们纳入了所有比较静脉注射拉贝洛尔与口服硝苯地平治疗妊娠重度高血压的 RCT，研究内容涉及相关疗效和安全性结局。
对纳入的研究进行了评估，并将数据提取到标准表格中。我们使用 Cochrane 评论管理软件进行定量分析。采用固定效应模型进行数据分析。
纳入的七项研究（四项来自发展中国家）共涉及 363 对母婴，其汇总分析结果显示，口服硝苯地平治疗与持续性高血压风险降低相关（RR 0.42，95%CI 0.18-0.96），且报告的母亲不良反应也较少（RR 0.57，95%CI 0.35-0.94）。但是，敏感性分析后，“持续性高血压”这一结局不再具有统计学意义。其他结局也未达到统计学意义。
口服硝苯地平与静脉注射拉贝洛尔同样有效且安全，在资源有限的环境下可能更具优势。
尽管目前的研究数量较少且规模较小，但硝苯地平在治疗妊娠重度高血压方面显示出了良好的前景。
