Keywords
How to Cite
Abstract
Objective: Hypertension affects approximately 10% of pregnancies worldwide, contributing significantly to maternal morbidity and mortality. Severe hypertension in pregnancy is defined as systolic blood pressure exceeding 160 mmHg and diastolic blood pressure greater than 110 mmHg, persisting for more than 15 minutes. This condition represents an obstetric emergency that necessitates immediate and appropriate management.
Methods: A quasi-experimental study was conducted at a tertiary care centre in Rawalpindi. The study included 70 patients, divided into two groups: Group 1 (n = 35) received oral nifedipine, while Group 2 (n = 35) was treated with intravenous labetalol. Treatment was initiated with 5 mg of oral nifedipine and 20 mg of intravenous labetalol as part of a gradual dose-escalation protocol designed to reduce pharmacological risks while ensuring effective blood pressure control.
Results: The findings revealed that therapeutic blood pressure was achieved significantly faster in the nifedipine group (mean time: 22.3 ± 11.5 minutes) compared to the labetalol group (mean time: 33.5 ± 13.3 minutes, p=0.03). Additionally, fewer doses were required in the nifedipine group than in the labetalol group. The rate of treatment failure was notably higher among patients treated with intravenous labetalol.
Conclusion: Oral nifedipine proved to be as efficacious and safe as intravenous labetalol, with the added advantage of convenience in low-resource settings.
Keywords: Pregnancy-induced hypertension, nifedipine, labetalol, failed treatment, Preeclampsia
References
Cífková R. Hypertension in pregnancy: a diagnostic and therapeutic overview. High Blood Pressure & Cardiovascular Prevention. 2023 Jul;30(4):289-303.https://doi.org/10.1007/s40292-023-00582-5
MBRRACE-UK Saving Lives Improving Mothers' Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21
Bromfield SG, Ma Q, DeVries A, Inglis T, Gordon AS. The association between hypertensive disorders during pregnancy and maternal and neonatal outcomes: a retrospective claims analysis. BMC Pregnancy and Childbirth. 2023 Jul 14;23(1):514. https://doi.org/10.1186/s12884-023-05818-9
Leonard SA, Siadat S, Main EK, Huybrechts KF, El-Sayed YY, Hlatky MA, Atkinson J, Sujan A, Bateman BT. Chronic hypertension during pregnancy: prevalence and treatment in the United States, 2008–2021. Hypertension. 2024 Aug;81(8):1716-23. https://doi.org/10.1161/HYPERTENSIONAHA.124.22731
Hashim S, Griffiths D, East C. Understanding knowledge and attitudes regarding hypertensive disorders of pregnancy among expectant women in Brunei Darussalam: A nationwide study. Midwifery. 2024 Oct 1; https://doi.org/10.1016/j.midw.2024.104116
Agarwal M, Rukshana M, Basu R, Shullai WK, Singh SA. Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation. Journal of Family Medicine and Primary Care. 2023 Dec 1;12(12):3119-22. https://doi.org/10.4103/jfmpc.jfmpc_2427_22
Li L, Xie W, Xu H, Cao L. Oral nifedipine versus intravenous labetalol for hypertensive emergencies during pregnancy: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2023 Dec 15;36(2):2235057.
https://doi.org/10.1080/14767058.2023.2235057
George R, Thomas C, Joy CA, Varghese B, Undela K, Adela R. Comparative efficacy and safety of oral nifedipine with other antihypertensive medications in the management of hypertensive disorders of pregnancy: a systematic review and meta-analysis of randomised controlled trials. Journal of Hypertension. 2022 Oct 1;40(10):1876-86. https://doi.org/10.1080/10641955.2023.2209637
Raja GP, Patil KP, Metgud MC, Savanur M, Malapure A, Hanji V. Intravenous Labetalol vs Oral Nifedipine in Acute Severe Hypertension in Pregnancy: A Randomised Controlled Trial. Journal of South Asian Federation of Obstetrics and Gynaecology. 2025 Mar 28;17(1):1-4.
https://doi.org/10.5005/jp-journals-10006-2602
Gahlot A, Vyas J, Ekta K. Oral Nifedipine and Intravenous Labetalol for Hypertensive Emergencies in Pregnancy: a Comparative Study. ESS Open Archive eprints. 2024 Jan 31;506:50628766. https://doi.org/10.22541/au.170666815.50628766/v1
Wu HZ, Cheng Y, Yu D, Li JB, Jiang YF, Zhu ZN. Different dosage regimens of nifedipine, labetalol, and hydralazine for the treatment of severe hypertension during pregnancy: a network meta-analysis of randomized controlled trials. Hypertension in Pregnancy. 2022 Apr 3;41(2):126-38.
https://doi.org/10.1080/10641955.2022.2056196
Monica G, Sultana SR. A Study of Comparing the Effectiveness of Intravenous Labetalol and Oral Nifedipine in Pregnancy-Related Hypertensive Emergencies. Journal of Contemporary Clinical Practice. 2023 Dec 29;9:7-14.https://doi.org/10.18683/jccp.2023.1091
Devadiga V, Veerendrakumar CM. Intravenous labetalol vs. oral nifedipine in control of hypertensive emergencies in severe pre-eclampsia and eclampsia: a randomized control trial. International Journal of Reproduction, Contraception, Obstetrics and Gynecology.;10(9):3526. DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20213479
Dhali B, Bhattacharya S, Ganguly RP, Bandyopadhyay S, Mondal M, Dutta M. A randomized trial of intravenous labetalol & oral nifedipine in severe pregnancy induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2012 Dec 1;1(1):42-7.
Shah MS, Verma M, Kumar S, Jivani H, Shah M, Jivani Jr HD. Effectiveness of Oral Nifedipine Versus Intravenous Labetalol in Controlling Hypertension in Severe Preeclampsia: A Comparative Study. Cureus. 2025 Jun 13;17(6).
Tolcher MC, Fox KA, Sangi-Haghpeykar H, Clark SL, Belfort MA. Intravenous labetalol versus oral nifedipine for acute hypertension in pregnancy: effects on cerebral perfusion pressure. American journal of obstetrics and gynecology. 2020 Sep 1;223(3):441-e1.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2025 Mahwash Jamil, Rubaba Abid Naqvi, Ayesha Basharat, Ayesha Akram