OS014. Which first-line drug to control severe hypertension in pregnancy? A pilot study

Introduction Severe hypertension is a common complication in pregnancy-associated hypertensive disorders and there is no clear consensus on which first-line antihypertensive drug to use in this setting. Objectives To determine the efficacy and safety of four antihypertensive drugs (two intravenous and two oral) in pregnant women with severe hypertension. Methods Pilot prospective randomised study. Inclusion criteria: pregnant women with a gestational age >24 weeks and admitted in the Obstetrics Department with severe hypertension defined as systolic blood pressure (SBP) ⩾165 mmHg and/or diastolic blood pressure (DBP) ⩾105 mmHg. The women were randomised in 4 groups to receive: −20 mg intravenous labetalol; −5 mg intravenous hydralazine; −10mg oral nifedipine tablets ; −10 mg sublingual nifedipine. Treatment was repeated every 20 mn until target SBP and DBP were reached (⩽150/⩽95 mmHg). The primary endpoint was the time needed to achieve effective blood pressure control. Treatment failure was defined as the unability to reach the target BP within one hour. Results After giving informed consent, 41 pregnant women admitted with severe hypertension were randomised. Mean age was 35 years (SD 3.5), 65% were nulliparous and mean SBP and DBP at admission were 176 (SD 16) and 105 (SD 12) mmHg, respectively. Success to achieve target BP was reached in all patients within the oral 10 mg nifedipine group (11 patients), in all but one patients with the 10 mg sublingual group (12 patients), and only in 5 out of 9 patients and 6 out of 9 patients within the labetalol and hydralazine groups. They were only one hypotension (defined as SBP