Vol 44 # 4 December 2012 - Kma.org.kw

December 2012
KUWAIT MEDICAL JOURNAL 288
College and associated Lok Nayak Hospital, New
Delhi from December 2006 and December 2008.
The study included patients selected according to
the criteria given below. Fifty patients were included
in the study.
Inclusion criteria
Pregnancy more than or equal to 20 weeks of
gestation, having severe hypertension i.e., systolic
blood pressure (SBP) of at least 160 mmHg and / or
diastolic blood pressure (DBP) of at least 110 mmHg
with or without proteinuria were included.
Exclusion criteria
Patients with cardiac failure, history of bronchial
asthma, bradycardia (pulse rate < 60 beats per minute),
allergic diathesis and eclampsia were excluded.
After taking history, doing a complete examination
and taking informed consent, either intravenous
labetalol or oral nifedipine were given to the patients
consecutively. Patients were divided into two groups
(i.e., group A - labetalol and group B - nifedipine).
Group A: Twenty fivepatientsreceivedintravenous
labetalol (n = 25), 20 mg intravenous bolus dose
initially, (if not effective within 20 minutes) followed
by escalating doses of 40 mg (2 nd dose), 80 mg (3 rd
dose), 80 mg (4 th dose), and then 80 mg (5 th dose)
every 20 minutes until the therapeutic blood pressure
goal of SBP < 160 mmHg and DBP < 110 mmHg was
achieved or up to a maximum dose of 300 mg or five
doses (Fig. 1).
Group B: Twenty five patients received oral
nifedipine (n = 25), 10 mg oral dose initially, with
repeated doses of 20 mg every 20 minutes until the
therapeutic goal (SBP < 160 mmHg and DBP of < 110
mmHg) was achieved or up to a maximum dose of
90 mg or five doses (Fig. 1).
The patients were then put on oral maintenance
dose of either oral labetalol 100 mg twice daily or
oral nifedipine 10 mg twice daily in addition to a
fixed dose of 250 mg thrice daily of α-methyl dopa
to start with. The dose of labetalol and nifedipine
were titrated to a maximum of 1200 mg of labetalol
or 60 mg of nifedipine in divided doses in the two
groups respectively.
The outcome measures were assessed in terms of
the control of the blood pressure i.e., SBP < 160 mmHg
and DBP < 110 mmHg. The time taken for the control
of blood pressure, the number of doses required was
noted and the patients were observed during the first
two hours.
Statistical analysis
Student’s t test was applied for comparing age,
fall in diastolic blood pressure, fall in systolic blood
pressure and average time required to control blood
pressure between the two groups. Fisher’s Z-test
was used for comparing the proportion of blood
pressure controlled in the two groups by single dose
of individual drug. A p-value of < 0.05 was regarded
as statistically significant
RESULTS
Table 1 shows the demographic data of the two
treatment groups. There were no significant differences
in ages between the two groups. The mean age at
presentation was 24.5 years in group A and 25.35 years
in group B. Seventy five per cent of patients were
Table 1: Demographic data
Patient classification
Group A
(Labetalol)
n = 25
Group B
(Nifedipine)
n = 25
Fig. 1: Flow chart showing methodology
Mean age (years)
Parity
Nullipara
Para 1
Para 2
Booked/Unbooked
Booked
Unbooked
Type of Severe Hypertension
Gestational hypertension
Pre-eclampsia
Chronic hypertension
Chronic hypertension with
Superimposed pre-eclampsia
24.50 ± 3.017
18
2
5
5
20
4
19
1
1
25.35 ± 3.74
10
12
3
4
21
5
17
2
1