OBJECTIVES

: Several anti-hypertensives are used for treating severe hypertension in pregnancy. The present study is a network meta-analysis comparing the efficacy and safety of these drugs.

METHODS

: Using an appropriate search strategy, electronic databases were searched for randomized clinical trials comparing drugs used for treating severe hypertension in pregnancy. Number of women achieving the target blood pressure (BP) was the primary outcome. Doses required and time taken for achieving the target BP, failure rate, and incidences of maternal tachycardia, palpitation, maternal hypotension, headache, stillbirth and neonatal death were the secondary outcomes. Mixed treatment comparison pooled estimates were generated using random-effects model. Odds ratio for the categorical and mean difference for the numerical outcomes were the effect estimates.

RESULTS

: Fifty-one studies were included in the systematic review and 46 in the meta-analysis. No significant differences in the number of patients achieving target BP was observed between any of the drugs. Nitroglycerine, nicardipine, diazoxide, nifedipine/celastrol, nifedipine/vitamin D and nifedipine/resveratrol were observed to achieve the target BP rapidly than hydralazine. Nifedipine requires fewer doses than hydralazine for achieving the target BP. Nitroglycerine and labetalol were associated with reduced incidences of tachycardia and palpitation respectively than hydralazine. Trial sequential analysis concluded adequate evidence for the comparison between hydralazine and nifedipine with labetalol.

CONCLUSIONS

: The present evidence suggest similar efficacy between nifedipine, hydralazine and labetalol in the treatment of severe hypertension in pregnancy. Subtle differences may exist in their safety profile. The evidence is inadequate for other drugs.