HYDRALAZINE BOLUSES FOR THE TREATMENT OF SEVERE HYPERTENSION IN PREECLAMPSIA

Objective To audit the use of bolus hydralazine for control of severe hypertension within a protocol for the management of severe pre-eclamp sia. Design A retrospective review. Setting Three UK teaching hospital s. Subjects Seventy consecutive women who received hydralazine for the treatment of sustained severe hypertension. Twenty-five women had mor e than one episode of hypertension amounting to a total of 109 treatme nt episodes. Intervention Intravenous bolus hydralazine 5 mg, repeated every 15 min to reduce the mean arterial pressure to < 125 mmHg. Main outcome measures Change in mean arterial pressure in response to bolu s hydralazine, fetal condition, as assessed by heart rate changes and umbilical arterial pH at delivery, and protocol violations were analys ed. Results Mean arterial pressure fell by 12 mmHg (95% CI 10-14) afte r the first bolus, 9 mmHg (95% CI 6.5-12) after the second bolus and 5 mmHg (95% CI 1-10) after the third bolus. Eighty-two (75%) episodes w ere managed strictly according to the protocol; of these, blood pressu re was controlled by bolus therapy alone in 89%. Of the 27 instances i n which the protocol was not adhered to, blood pressure was not contro lled in four. There were no significant differences in the incidence o f cardiotocographic abnormalities or umbilical acidaemia in the women treated before delivery (n = 36) compared with those in whom treatment was first initiated afterwards (n = 34). Conclusions Hydralazine give n in 5 mg boluses is a safe and effective method of treating severe hy pertension in pre-eclampsia. Despite clear management guidelines, prot ocol violations were common, and in 4% of treatment episodes these wer e potentially serious resulting in failure to control blood pressure.