Nephrology Dialysis Transplantation, Vol 13, Issue 2 316-323, Copyright © 1998 by Oxford University Press
J Wacker, P Werner, I Walter-Sack and G Bastert
Background. The primary objective of treatment in
women with severe hypertension and pre-eclampsia is to prevent
complications such as encephalopathy and haemorrhage. In many countries
dihydralazine is considered the drug of choice for treating hypertension in
pregnancy, because it now has been used safely for about 30 years, and the
introduction of a new drug in pregnancy is a difficult task with partially
unknown hazards. In some other countries combined alpha- and beta- blockers
are also used. Taking into account that some patients with pre-eclampsia do
not respond to dihydralazine and the drug has serious side-effects like
headache and reflex tachycardia, there is some need for developing
alternative treatment strategies using drugs that are more adequate for
pregnancy than dihydralazine. Methods. Urapidil is a
post-synaptic &agr;1 adrenoceptor antagonist, which is widely used to
control hypertensive crises unrelated to pregnancy. Since it is known that
pre-eclampsia is associated with increased sympathetic activity,
administration of an &agr;1 adrenoceptor antagonist provides a
reasonable therapeutic basis. So far there is only one report describing
the i.v. use of urapidil in the treatment of hypertension in pregnancy
unresponsive to dihydralazine and one report which describes the oral use
of urapidil. In an earlier pilot study we examined the dose range for i.v.
application of urapidil necessary for adequate blood pressure control in
patients with pre-eclampsia. In the present randomized controlled study 26
white women with pre-eclampsia and hypertension in pregnancy were included.
Treatment was not blinded. During the initial period of intensive
intravenous treatment all subjects were under constant surveillance by a
physician and a nurse. Results. Effective prolonged
control of blood pressure (values below 150/100 mmHg) was achieved in all
patients of the two groups. In one patient of the dihydralazine group signs
of lightheadedness and near syncope were noted. After this side-effect of
dihydralazine the patient was treated with urapidil. At the end of the
observation period the maternal heart rate in the dihydralazine group was
higher than in the urapidil group. Conclusions. Since
urapidil decreased the high blood pressure in patients with pre-eclampsia
without serious side-effects urapidil appears preferable superior to
dihydralazine. The haemodynamic effects of urapidil were more predictable
than those of dihydralazine. The reduction of intracerebral pressure could
be an additional advantage of urapidil in the treatment of patients with
pre-eclampsia Keywords: dihydralazine; hypertension;
pre-eclampsia; pregnancy; treatment; urapidil
ORIGINAL ARTICLES
Treatment of hypertension in patients with pre-eclampsia: a prospective parallel-group study comparing dihydralazine with urapidil
Departments of Obstetrics and Gynecology and Clinical Pharmacology, University of Heidelberg, Voßsraße 9, D-69115 Heidelberg, Germany; Corresponding author
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