Hypertension commonly affects women in pregnancy, and is associated with adverse effects for both mother and baby. Currently, there is a lack of consensus on the relative efficacy and safety of oral medications used in treating severe hypertension in pregnancy, defined as systolic blood pressure of at least 160 mm Hg or diastolic blood pressure of at least 110 mm Hg. In this multicentre randomized controlled trial, 894 women were randomized to receive one of three oral antihypertensives (labetalol, nifedipine retard, methyldopa) to compare the efficacy and safety of these oral agents in the management of severe hypertension in pregnancy. The primary outcome was blood pressure control, defined as 120-150 mm Hg systolic blood pressure and 70-100 mm Hg diastolic blood pressure, within 6 hours with no adverse outcomes. Researchers found that the primary outcome occurred more often in the nifedipine group (84%) compared to the methyldopa group (76%) (p=0.03). The proportion of women achieving the primary outcome in the nifedipine and labetalol groups, however, was comparable (p=0.05). The labetalol and methyldopa groups were also similar in this regard (p=0.80). The findings of this study therefore support the use of oral nifedipine as a single agent in the management of severe hypertension in pregnancy, though all of the studied oral antihypertensives demonstrate efficacy in this patient population.
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