Hypertension during pregnancy: Studies reveal an oral, inexpensive treatment for controlling BP

High blood pressure (BP) is always bad news, especially among pregnant women. However, a recent study has found that administering oral drugs like nifedipine to pregnant women can help control BP in just six hours, potentially saving lives. Conducted in a Nagpur hospital, the study of 894 women sought to answer a simple question: in places where it’s not possible to give antihypertensive drugs intravenously — that is, through an IV — or to constantly monitor foetal health while administering the medicine, what is the best way to bring blood pressure down quickly and relatively safely? [caption id=“attachment_5283931” align=“alignleft” width=“380”]  Representational image. Reuters[/caption] Prof Thomas Easterling, et al., published their findings in The Lancet earlier this month, in the article ‘Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial’. The magnitude of the issue In India, 11% of women and 15% of men in the age group 15-49 have hypertension, according to the latest National Family Health Survey. Bad as it is for everyone, hypertension is worse in pregnant women. “Even among the general population, hypertension is known as the silent killer,” said Dr Archana Nirula, medical officer at myUpchar.com. “Hypertension complicates one in ten pregnancies in India,” she said. Around 7.8% of pregnant women get hypertension in India, and 5.6% get preeclampsia - a potentially fatal condition. Gestational hypertension, or hypertension that resolves itself after the pregnancy, occurs in 1.5% of women, according to a study by Pune-based researchers Manjusha Sajith and Vandana Nimbargi, among others - this research was published in the International Journal of Pharma Sciences and Research in April 2014. “The world over, around 30,000 pregnant women die from complications because of hypertension,” Dr Nirula said. Potential solution “It’s very important to quickly bring blood pressure under control,” Dr. Nirula said. “Not only is it bad for the mother’s heart and brain health, but it can also be harmful to the baby too. When the foetus doesn’t get proper blood, oxygen and nutrition from the mother, he/she could weigh less at birth,” she explained. The Lancet study isn’t the first to talk about the efficacy of oral drugs like methyldopa and nifedipine to treat hypertension. However, what makes the study important is that unlike other studies, it makes a clear recommendation to treat hypertension in areas where access to IV medication and foetal monitoring are limited. “There is no consensus on the relative efficacy and safety of the medications to treat severe hypertension in pregnancy, and the most recent Cochrane review found insufficient data to recommend a specific drug, concluding that the choice of antihypertensive should be guided by clinicians’ experience and familiarity with the drug, known adverse effects, and women’s experiences,” the authors of The Lancet report wrote. In an ideal world with equal opportunities and universal availability of good diagnosticians and gynaecologists, the clinician’s recommendation would be the perfect solution. But we don’t live in that world - yet. In this context, the authors’ findings that easily available, inexpensive (roughly Rs 9-16, depending on the brand) oral medicines can work when IV drips aren’t feasible, and that nifedipine works better than methyldopa or labetalol - also an oral drug - could save lives. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. To know more on this topic, please visit  https://www.myupchar.com/en/disease/preeclsia-and-eclsia