Obstetric aspects of the use in pregnancy-associated hypertension of the beta-adrenoceptor antagonist atenolol. l-Arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications A PROSPECTIVE CONTROLLED TRIAL OF METOPROLOL‐HYDRALAZINE TREATMENT IN HYPERTENSION DURING PREGNANCY Beta-blocker/thiazide combination for treatment of hypertensive children: a randomized double-blind, placebo-controlled trial. Antihypertensive Drug Effects on Placental Flow Velocity Waveforms in Pregnant Women with Severe Hypertension PLACEBO-CONTROLLED TRIAL OF ATENOLOL IN TREATMENT OF PREGNANCY-ASSOCIATED HYPERTENSION ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. Neonatal Effects of Beta‐Blocking Drugs in Pregnancy Comparison of labetalol and dihydralazine in hypertensive emergencies of pregnancy. Early blood pressure control improves pregnancy outcome in primigravid women with mild hypertension. Crossover design to test antihypertensive drugs with self-recorded blood pressure. [Acebutolol in the treatment of arterial hypertension in pregnancy--comparison with commonly used hypertensive agents]. [Management of severe pre-eclampsia/eclampsia. Comparison between nifedipine and hydralazine as antihypertensive agents]. Calcium channel blockade (isradipine) in treatment of hypertension in pregnancy: a randomized placebo-controlled study. Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. Prevention of hypertensive disorders of pregnancy. Nifedipine in acute hypertensive emergencies in pregnancy.
The obstetric implication s of the use of the beta-adrenoceptor antagonist atenolol have been evaluated in a prospect i ve , r and omized , double-blind , and placebo-controlled study involving 120 women with pregnancy-associated hypertension . The clinical interpretation of antenatal and intrapartum cardiotocographs was uninfluenced by atenolol .  Human placental lactogen concentration fell in the atenolol group , but this was not an indicator of subsequent fetal distress . Other obstetric indices , such as urinary estriol excretion , were the same in both groups . Spontaneous premature labor occurred in five women receiving placebo but in none who received atenolol . Together with previously reported findings on pregnancy outcome , our study leads us to conclude that beta-blockers such as atenolol can appropriately be used in the management of hypertension during pregnancy Objective . To evaluate l-arginine ( l-Arg ) supplementation in pregnant women with chronic hypertension and its effects on blood pressure ( BP ) and maternal and neonatal complications . Methods . We enrolled 80 women affected by mild chronic hypertension referred to the High Risk Clinic of the Mother – Infant Department of the University of Modena and Reggio Emilia . Each woman after obtaining oral consent was r and omized to receive oral l-Arg versus placebo and thereafter su bmi tted to 24-h ambulatory BP monitoring . The primary outcome was BP change after 10–12 weeks of treatment . Secondary outcomes were as follows : percentage of women on antihypertensive treatment at delivery , maternal , and fetal outcome . Results . The BP changes after 10–12 weeks of treatment did not differ between groups . A lower percentage of women received antihypertensive drugs in the l-Arg group than the placebo group . The incidence of superimposed preeclampsia indicated delivery before the 34th weeks and certain neonatal complications tended to be higher in the placebo group . Conclusions . l-Arg supplementation in pregnant women with mild chronic hypertension does not significantly affect overall BP but is associated with less need for antihypertensive medications and a trend toward fewer maternal and neonatal complications . The results of the study were limited by the small sample size and by the exclusion of women with severe chronic hypertension . In our policy , these patients needed many hypertensive drugs and were normally managed by the cardiologist . Nevertheless , considering the promising results on maternal and fetal outcome , we believe that further studies should be performed to confirm such data and to clarify the role of l-Arg as a protective supplement in high-risk pregnancy Abstract . in an open , controlled trial , treatment with a combination of metoprolol and hydralazine was compared with non‐pharmacological management of mild and moderate hypertension in pregnancy . One hundred and sixty‐one women participated in the study . the drug‐treated group showed significantly better blood pressure control than the group not given antihypertensives .  Induction of labor before term , because of maternal or fetal complications , was somewhat more frequent in the control group . Nine women in the treatment group and 5 in the control group developed albuminuria . Three infants in the drug‐treated group died perinatally , and one in the control group . the outcome for the newborns was similar in both groups concerning birth weight , head circumference and Apgar score and in the frequencies of respiratory distress , bradycardia and hypoglycemia . the better blood pressure control achieved with these drugs makes it possible to treat the patient at home and reduce the risk of emergency delivery , but treatment does not seem to be m and atory for a good outcome of the pregnancy in cases of mild and moderate hypertension during pregnancy Antihypertensive medications are used extensively in children despite a paucity of r and omized , placebo-controlled trials . This study was among the first r and omized , controlled pediatric antihypertensive medication trials , in which the combination drug bisoprolol fumarate/hydrochlorothiazide ( B/HT ) was compared with placebo . The study comprised a 2-week single-blind placebo screening period , a 6-week double-blind dose titration period , a 4-week double-blind dose maintenance period , and a 2-week double-blind dose-tapering period . One hundred and forty subjects were enrolled to achieve 94 r and omized subjects treated either with B/HT ( n=62 ) or placebo ( n=32 ) . B/HT induced significant reductions compared with placebo for average sitting systolic blood pressure ( SiSBP ) ( 9.3 vs. 4.9 mmHg , P<0.05 ) and sitting diastolic blood pressure ( SiDBP ) ( 7.2 vs. 2.7 mmHg , P<0.05 ) . The placebo-subtracted BP reductions were greater in younger children and those with more-severe baseline hypertension . The percentage of subjects with BP less than the 90th percentile at study completion was 45 % for B/HT and 34 % for placebo ( P = NS ) . Although the study demonstrated that B/HT  reduced BP safely compared with placebo , the large placebo effect and failure of most subjects to achieve target BP control make it uncertain whether B/HT is appropriate first-line therapy for pediatric hypertension , particularly in adolescents with mild-to-moderate BP elevation Summary : Doppler studies of the uterine and umbilical arteries were performed in 24 acutely hypertensive pregnant women . Women were divided into 2 groups : Group 1 ( diastolic blood pressure (DBP)>110 mm Hg ) received placebo ( n = 6 ) or 10 mg oral nifedipine ( n = 9 ) ; Group 2 ( DBP ≥ 110 mm Hg ) received 10 mg oral nifedipine ( n = 5 ) or 10 mg intravenous hydralazine ( n = 4 ) . Treatment allocations were r and om within groups and the investigator and patient were blind to the treatments . Baseline flow velocity waveforms ( FVW ) and posttreatment FVW 's at 30 , 60 and 120 minutes were recorded . There was no significant difference between baseline and posttreatment FVW indices within or between groups . Placebo was as effective as nifedipine in lowering blood pressure over 2 hours of study . There were no significant adverse effects of treatment Atenolol was compared with placebo in a r and omised and double-blind prospect i ve study of 120 women with mild to moderate pregnancy-associated hypertension who were also initially managed conventionally by bed rest .  Atenolol given once daily significantly reduced blood-pressure , prevented proteinuria , and reduced the number of hospital admissions . Loss of blood-pressure control leading to withdrawal from the study was commoner among the placebo group , whose babies had a high morbidity . Respiratory distress syndrome occurred only in the placebo group . Intrauterine growth retardation , neonatal hypoglycaemia , and hyperbilirubinaemia occurred with the same frequency in the two groups . Neonatal bradycardia was more common after atenolol but the systolic blood-pressure of the babies was the same in both groups . There was no difference between the groups in maternal symptoms which could have been attributed to beta-blocker therapy . Thus atenolol is more effective than conventional obstetric management in this form of hypertension and does not adversely affect mother or baby The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure ( SBP ) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy . Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits . Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each . The study was a balanced , r and omized crossover design with five periods : placebo ; angiotensin converting enzyme inhibitors ; beta-blocking drugs ; calcium-blocking drugs ; and thiazide diuretics .  Blood pressure ( BP ) was measured 24 to 26 h after the previous dose . A question naire for side effects was administered at each visit . Seventy-four patients entered the study . beta-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods . There were 9 of 66 patients on P , 9 of 46 on beta-blockers , 4 of 65 on calcium-blocking drugs , 4 of 65 on diuretic , and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects . Decreases in SBP compared to r and omized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = beta-blockers 5 mm Hg . Blood pressure decrease correlated with placebo BP ( P < .0005 , r = 0.53 to 0.70 ) . When corrected for placebo , target SBP ( < 140 mm Hg ) was reached in between 6 % to 15 % of patients on monotherapy . Sequential monotherapy achieved target in 29 % . Angiotensin converting enzyme inhibitors , calcium-blocking drugs , and diuretics had no more side effects than placebo . Patients on beta-blockers had more side effects and the well-being score was reduced . Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure . beta-Blockers were relatively ineffective , were frequently contraindicated , and had more side effects . Monotherapy achieved control in only a small number of patients . In elderly people with essential hypertension , therapy should be instituted with diuretics or calcium-blocking drugs , but combination therapy will usually be required to achieve goal Abstract . A review is presented as regards the neonatal effects of beta‐blocking agents in hypertension during pregnancy . Experience points to low fetal and neonatal risks , but firmly based data concerning the neonates are very scanty . An on‐going double‐blind study is presented in which pregnant women with hypertension are r and omly allocated to either metoprolol or placebo treatment . One of the aims is to study the postnatal adaptation of the infants . The following measurements , recordings and examinations are performed : anthropometric measurements , Apgar score , blood gases and acid‐base status in umbilical ( venous and arterial ) blood , lactate and hypoxanthine in umbilical venous blood , catecholamines in umbilical arterial blood , pulse rate , blood glucose and a quantitative neurobehavioral assessment in the neonatal period Labetalol ( Tr and ate ; Allen & Hanburys ) , a combined alpha- and beta-adrenergic blocking agent , was compared with the more commonly used peripheral vasodilator , dihydrallazine ( Nepresol ; Ciba ) , each administered as an infusion , in the treatment of severe hypertension in 20 primigravidas at greater than or equal to 32 weeks ' gestation . With the dosage regimen used in this study there was a tendency towards more effective blood pressure control with dihydrallazine . The pulse rate was unaffected by labetalol therapy and there were no harmful effects on the neonate or fetus directly attributable to either drug OBJECTIVE AND DESIGN The aim of this study was to evaluate treatment of mild to moderate hypertension ( less than 170/110 mmHg ) in pregnancy in a prospect i ve , r and omised , double-blind trial . SETTING AND PATIENTS Pregnancy outcome was studied for 52 primigravid women , managed in hospital from early in the third trimester . INTERVENTIONS Patients were r and omly allocated either to placebo or to active treatment ( clonidine plus hydralazine ) . MAIN OUTCOME MEASURES AND RESULTS Maternal deterioration dictated withdrawal from trial therapy for eight patients receiving placebo , but for only one receiving active treatment . Maternal proteinuria occurred only in the placebo group . Intention-to-treat analysis showed a significant increase in premature delivery for complications in the placebo group ( P less than 0.05 ) , despite active blood pressure treatment for those withdrawn from the group because of severe hypertension ( 170/110 mmHg or higher ) . Neonatal respiratory distress requiring intensive care occurred only in babies born to women in the placebo group . There were no perinatal deaths and no adverse effects of treatment in the neonates . CONCLUSIONS The study indicates that early control of mild hypertension in pregnancy can prevent progression to emergency premature delivery In a double-blind , within-patient study , blood pressure was measured at regular intervals at the clinic by the physician and each day at home by the patient . Both methods of blood pressure measurement demonstrated an antihypertensive effect of the diuretics chlorthalidone ( 25 mg ) and triamterene ( 50 mg ) and the beta-blocker oxprenolol ( 160 mg ) and the greater efficacy of the combination of the two therapies . During placebo , as well as during active treatment , blood pressure values were higher at the clinic than at home , except when the patients were taking the beta-blocker , which minimized the arousal response during blood pressure measurements in the clinic . With 2-week treatment periods , separated by 2 weeks of placebo administration , blood pressure returned toward its initial level after each of the three treatments and none of the carryover effects was significant at the 5 % level . This methodology was intended to make it possible to demonstrate in 27 patients at the clinic and in 20 patients with measurements made at home , at the usual statistical risks ( alpha = 5 % , beta = 10 % ) , a fall of 5 mm Hg in diastolic blood pressure in comparison with a placebo . Moreover , at the end of this 3-month follow-up , each patient could continue to receive the treatment that was the most effective and the best tolerated . In conclusion , the use of a within-patient trial design , with a 15-day washout period between active treatments and careful recording of blood pressure values , can minimize the number of patients included in hypertension trials and offer to each patient the possibility of individualization of treatment OBJECTIVE The main purpose of our study was to analyse efficacy and safety of acebutolol ( Sectral ) in the treatment of hypertension in pregnancy . DESIGN Cohort clinical study comparing efficacy and safety of acebutolol with other antihypertensive drugs by 77 patients and their 81 newborns . The number of 48 patients were treated by acebutolol .  SETTING Internal Medicine and Clinical Pharmacology Department , Regional Hospital , Nitra and The Faculty of Health Service and Social Work , University of Trnava ; Department of Gynaecology and Obstetrics , Regional Hospital Nitra and The Faculty of Health Service and Social Work , University of Trnava ; Institute of Pharmacology , The Faculty of Medicine , Komenského University , Bratislava ; Environment , a.s . Nitra . METHODS During the period of 6 years our patients were divided into subgroups according to the type of hypertension in pregnancy and the severity of the illness which was the basis for used antihypertensive drugs . One of the topics of the study was to provide monitoring of adverse events by mother and possible drug influence on their new-born has been evaluated by investigating the week of birth , weight and length of the new-born and evaluating of Apgar score . RESULTS In the subgroup of 48 women treated by acebutolol we have confirmed the efficacy and safety of this antihypertensive drug without any clinical ly significant effect on the quality of life of their new-born and evaluating of Apgar score . CONCLUSION With regard to the results of our clinical study we can consider acebutolol to be effective and safe antihypertensive drug in the treatment of hypertension in pregnancy The objective was to compare the fetal and maternal effects between parenteral hydralazine and sublingual nifedipine used like antihypertensive drugs in the management of severe preeclampsia .  Study design was prospect i ve , comparative , longitudinal , r and omized clinical trial . It was carried out at Centro Medico Nacional IMSS Torreon , Coah . Gynecology and Obstetrics Department . The patients were women in the last trimester of pregnancy with severe preeclampsia were r and omized to receive parenteral hydralazine or sublingual nifedipine as antihypertensive drugs . The only difference observed in this study was the Apgar of neonates whose mothers received hydralazine , that was significatively lesser than the Apgar of neonates whose mothers received nifedipine . Both medicaments are a good alternative as antihypertensive drugs in severe preeclampsia . Neonates whose mothers received Nifedipine had a higher Apgar OBJECTIVE Our purpose was to study the effects of isradipine , a dihydropyridine calcium channel blocker , on mother and fetus in the treatment of hypertensive disorders of pregnancy . STUDY DESIGN The investigation was performed as a two-group , parallel , double-blind multicenter study of isradipine versus placebo .  Fifty-four women were r and omized to treatment with isradipine slow-release capsules given orally 5 mg twice a day and 57 to a  placebo group . RESULTS Isradipine lowered the maternal mean arterial blood pressure effectively in women with nonproteinuric hypertension but did not do so in women with proteinuria at recruitment or appearing during treatment . Blood flow in the umbilical artery and maternal renal and liver function were not influenced by treatment . Isradipine had few side effects and was well tolerated . CONCLUSION Calcium channel blockade with isradipine is effective for treatment of nonproteinuric hypertension but not in preeclampsia Men aged 40 - 64 years with mild to moderate hypertension [ diastolic blood pressure ( DBP ) 100 - 130 mmHg ] were r and omized to treatment with a  diuretic ( n = 3272 ) or a  beta-blocker ( n = 3297 ) , with additional drugs if necessary , to determine whether a beta-blocker based treatment differs from thiazide diuretic based treatment with regard to the prevention of coronary heart disease ( CHD ) events and death .  Patients with previous CHD , stroke or other serious diseases , or with contraindications to diuretics or beta-blockers were excluded . If normotension ( DBP less than 95 mmHg ) was not achieved by monotherapy , other antihypertensive drugs were added , but the two basic drugs were not crossed over . Patients were assessed at 6-monthly intervals . The mean follow-up for end-points was 45.1 months . Blood pressure ( BP ) side effects and end-points were recorded in a st and ardized manner . Entry characteristics and the BP reduction achieved were very similar in both treatment groups . All analyses were made on an intention-to-treat basis . The incidence of CHD did not differ between the two treatment groups . The incidence of fatal stroke tended to be lower in the beta-blocker treated group than in the diuretic treated group . Total mortality and the total number of end-points were similar in both groups . The percentage of patients withdrawn due to side effects was similar , whereas the number of reported symptoms , according to a question naire , was higher for patients on beta-blockers . The incidence of diabetes did not differ between the two groups . Subgroup analyses did not detect a difference in the effect of beta-blockers compared with diuretics in smokers as opposed to non-smokers , and beta-blockers also had the same effects as diuretics in the quartile with the highest predicted risk for CHD . Beta-blockers and thiazide diuretics were approximately equally well tolerated . The two drugs had a similar BP reducing effect although additional drugs had to be given more often in the diuretic group . Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications , including CHD , to a different extent A prospect i ve r and omised clinical trial comprising 510 pregnant patients was performed to determine whether supplementation with calcium , low-dose aspirin or a combination of calcium and low-dose aspirin can lower the incidence of hypertension in pregnancy . Greatest benefits were obtained with calcium .  Perinatal mortality was lowest in the aspirin group The effect of nifedipine ( Adalat ; Bayer-Miles)--a calcium channel blocker , which has a well-established place in nonobstetric hypertension -- was compared with dihydralazine in 33 primigravidas with severe hypertension of pregnancy . Patients with a diastolic blood pressure greater than 110 mmHg before drug administration were r and omly assigned to treatment with either nifedipine or dihydralazine . Both drugs were found to be equally efficacious .  Nifedipine , however , showed an earlier onset of action in lowering systolic blood pressure and had the advantage of oral administration
Beta-blockers appear to be no more effective and probably equally as safe .
It is unusual for women to change drugs due to side effects .
REVIEW ER 'S CONCLUSIONS Improvement in control of maternal blood pressure with use of beta-blockers would be worthwhile only if it were reflected in substantive benefits for mother and /or baby , and none have been clearly demonstrated .
Large r and omised trials are needed to determine whether antihypertensive therapy in general ( rather than beta-blocker therapy specifically ) results in greater benefit than risk , for treatment of mild-moderate pregnancy hypertension .
BACKGROUND Antihypertensives , such as beta-blockers , are used for pregnancy hypertension in the belief these will improve outcome for mother and baby .
OBJECTIVES To assess whether oral beta-blockers are better than placebo , or no beta-blocker , and have advantages over other antihypertensives , for women with mild to moderate pregnancy hypertension .