Oral regimen management of acute hypertension in pregnancy

Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality worldwide, and they are directly responsible for approximately 14% of maternal deaths.1 Often, women present in hypertensive urgency, requiring rapid pharmacological intervention to prevent severe complications.2 The largest burden of disease is found in low-income and middle-income countries (LMICs),1 where poor access to refrigeration, trained health-care professionals, fetal monitoring, and drug options create substantial challenges to the administration of rapid-acting intravenous medications. [...]the choice of lifesaving antihypertensives in treatment of maternal severe hypertension is often determined by clinician preference, cost, and local availability.6 In The Lancet, Thomas Easterling and colleagues7 report the first, to our knowledge, RCT directly comparing the three most common oral antihypertensives for the treatment of severe acute hypertension in two public hospitals in Nagpur, India. All three drugs were effective first-line treatments in controlling severe hypertension in the short-term without adverse maternal outcomes, the primary outcome of the study: 249 (84%) women in the nifedipine group, 228 (77%) women in the labetalol group, and 230 (76%) women in the methyldopa group had a systolic blood pressure of 120–150 mm Hg and a diastolic blood pressure of 70–100 mm Hg within 6 h of study drug administration.