From the Guidelines
Labetalol is the first-line pharmacologic treatment for pre-eclampsia, particularly for hypertensive emergencies during pregnancy. According to the most recent guidelines, labetalol i.v. and oral nifedipine are currently suggested as first-line treatment for hypertensive emergencies during pregnancy 1. This recommendation is further supported by the 2024 ESC guidelines, which recommend drug treatment with i.v. labetalol or nicardipine and magnesium in pre-eclampsia or eclampsia with hypertensive crisis 1.
Key Considerations
- Blood pressure > 160/110 mmHg lasting > 15 min warrants immediate drug treatment 1
- Methyldopa should not be used primarily for urgent BP reduction 1
- Magnesium sulfate is recommended for the prevention of eclampsia and treatment of seizures, but should not be given concomitantly with calcium channel blockers due to the risk of hypotiction 1
- Labetalol, nifedipine, enalapril, and metoprolol are considered safe for breastfeeding mothers 1
Treatment Approach
- Labetalol i.v. is the preferred first-line treatment for hypertensive emergencies during pregnancy 1
- Oral nifedipine is also a suggested first-line treatment for hypertensive emergencies during pregnancy 1
- Magnesium sulfate should be used for the prevention of eclampsia and treatment of seizures, with careful monitoring for signs of toxicity 1
From the Research
First-Line Pharmacologic Treatment for Pre-eclampsia
The first-line pharmacologic treatment for pre-eclampsia includes several options, with the choice of agent depending on various factors such as symptom severity and gestational period.
- Nifedipine and labetalol are commonly used for the treatment of pregnancy-induced severe pre-eclampsia 2, 3.
- Hydralazine is also used as a first-line agent to control hypertension in severe pre-eclampsia, although it may have a higher incidence of adverse outcomes 4, 5.
- According to a study, nifedipine is safe and more effective than hydralazine in controlling blood pressure in severe pre-eclampsia 4.
- Another study found that intravenous labetalol is faster in restoring blood pressure in pregnant women with pre-eclampsia than oral nifedipine and may be used as a first-line drug in the acute control of blood pressure in a hypertensive emergency during pregnancy 3.
- A comparative study of oral nifedipine, labetalol, and hydralazine found that nifedipine is the most effective drug to reduce blood pressure when single dose administration is used, but requires more doses to further reduce the blood pressure 6.
Comparison of Antihypertensive Agents
The effectiveness of different antihypertensive agents in reducing blood pressure in patients with severe pre-eclampsia has been compared in several studies.
- A study found that nifedipine, labetalol, and hydralazine are all effective in reducing blood pressure, but with different response rates and side effect profiles 6.
- Another study compared the efficacy and safety of oral nifedipine and intravenous labetalol for severe pre-eclampsia therapy and found that both agents are effective and safe, but with no significant difference in time to achieve target blood pressure 2.
- The choice of antihypertensive agent may depend on factors such as the severity of hypertension, the presence of maternal or fetal compromise, and the gestational period 5.