NIFEDIPINE VERSUS EXPECTANT MANAGEMENT IN MILD-TO-MODERATE HYPERTENSION IN PREGNANCY

Objective To compare the effect of routine treatment with the calcium channel blocker nifedipine in mild to moderate hypertension in pregnan cy. Design Randomised clinical trial. Setting General and University h ospitals. Participants Pregnant women, between 12 and 34 weeks of gest ation, with chronic, pregnancy-induced or unclassifiable hypertension and diastolic pressure between 90 and 110 mmHg. Methods Eligible women were randomly assigned treatment with slow-release nifedipine, 10 mg twice daily until delivery, or no treatment. In the no treatment group nifedipine was given if the diastolic pressure exceeded 110 mmHg. A t otal of 145 women were assigned nifedipine and 138 no treatment. Resul ts In the nifedipine group 45.0% of women were delivered before let-mi compared with 37.0% in the no treatment group; the difference was not significant. In all, 56.3% of women allocated nifedipine and 62.1% al located no treatment underwent caesarean section; the difference was n ot statistically different (OR 0.7, 95% CI 0.4-1.1). There was no sign ificant difference between the two groups in the percentage of babies weighing less than the 10th centile (OR 0.8; 95% CI 0.4-1.4) or in the mean birthweight. The frequency of admission of infants to the neonat al intensive care unit was not affected by treatment. Conclusions This trial found no benefit on pregnancy outcome of routine treatment with nifedipine. In clinical practice, the treatment of hypertension in pr egnancy may be delayed until the hypertension becomes severe.